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Case Report
Spina ventosa in an 18 year old
Vikram Khanna a,*
, Raju Vaishya a
, Vipul Vijay a
, Vivek Vaibhav b
a
Departm...
and the incidence of spina ventosa in children with tubercu-
losis is 0.65%e6.9%.2
Our case was unusual being 18 year old
...
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Spina ventosa in an 18 year old

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An 18 year old female presented with painless swelling and a chronic discharging sinus at the base of right thumb for last 6 months. The swelling was insidious in onset and progressively increasing in size. She was also suffering from pulmonary tuberculosis.

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Spina ventosa in an 18 year old

  1. 1.                                                                                                                                        Spin        na ventossa in an 1      8 year oldd
  2. 2. Case Report Spina ventosa in an 18 year old Vikram Khanna a,* , Raju Vaishya a , Vipul Vijay a , Vivek Vaibhav b a Department of Orthopaedics, Indraprastha Apollo Hospitals, New Delhi, India b Department of Orthopaedics, Era Medical College, Lucknow, India Keywords: Tuberculosis Dactylitis Granuloma 1. Description An 18 year old female presented with painless swelling and a chronic discharging sinus at the base of right thumb for last 6 months. The swelling was insidious in onset and progres- sively increasing in size. She was also suffering from pulmo- nary tuberculosis. Local examination revealed a spindle shaped swelling of 3 cm  2 cm over the right 1st metacarpal. This swelling was bony hard tender and was fixed to under- lying bone with a pus discharging sinus (Fig. 1). X-ray showed a cystic expansile lesion of right 1st metacarpal (Fig. 2). There was an increase in ESR (24 mm at 1 h). Montoux test and sputum for AFB were positive. Histopathological examination revealed an epitheloid granuloma with Langhans' giant cells suggestive of tuberculosis (Fig. 3). She was given a course of antituberculosis treatment for 12 months. At 1 year follow up, the discharging sinus had healed and the ESR had returned to normal, but the bony swelling had persisted. Tubercular dactylitis (spina ventosa) is an uncommon presentation of tuberculosis. It is characterised radiologically by spindle shaped cystic swelling of the short tubular bones.1 About 80e85% of cases occur below the age group of 6 years Fig. 1 e Clinical picture of the thumb showing a spindle shaped swelling and a discharging sinus wound on the thumb. * Corresponding author. Tel.: þ91 9643378323. E-mail address: 86.khanna@gmail.com (V. Khanna). Available online at www.sciencedirect.com ScienceDirect journal homepage: www.elsevier.com/locate/apme a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e2 Please cite this article in press as: Khanna V, et al., Spina ventosa in an 18 year old, Apollo Medicine (2014), http://dx.doi.org/ 10.1016/j.apme.2014.07.001 http://dx.doi.org/10.1016/j.apme.2014.07.001 0976-0016/Copyright © 2014, Indraprastha Medical Corporation Ltd. All rights reserved.
  3. 3. and the incidence of spina ventosa in children with tubercu- losis is 0.65%e6.9%.2 Our case was unusual being 18 year old which is rare because spina ventosa is generally seen in children in whom the blood supply to the bones is profuse and better than that in adults. We believe, that in our case since there was considerable bacterial load, the tubercular infection could lodge and flare even in a small tubular bone in this adolescent girl causing dactylitis. Despite a full control of infection, the bone swelling persisted as these lesions heal with sclerosis. Tubercular dactylitis can mimic other conditions like inflammatory lesions (pyogenic infection, syphilis, brucellosis, sarcoidosis), neoplastic conditions (enchondroma, fibrous dysplasia) and foreign body pricks (thorn, wooden splinters).3 Awareness about this condition and high index of suspicion is required to establish an early diagnosis. 2. Learning points/take home message Spina ventosa or tubercular dactylitis can present as painless swelling of the digits, in isolation or in a dessi- minated form. Awareness about this condition is necessary to reach to an early diagnosis. Radiologically, there is often fusiform expansion of the involved short tubular bone. Conflicts of interest All authors have none to declare. r e f e r e n c e s 1. Kushwaha R, Kant S, Verma SK, Mehra S, Mehra S. Isolated metacarpal bone tuberculosis e a case report. Lung India. 2008;25:17e19. 2. Gyanshankar PM, Dhamgaye TM, Amol BF. Spina ventosa discharging tubercle bacilli e a case report. Indian J Tuberc. 2009;56(2):100e103. 3. Vaishya R. “A thorny problem”: diagnosis treatment of acacia thorn injuries. Injury. 1989;21:97e100. Fig. 2 e X-ray showing spindle shaped expansion of the 1st metacarpal. Fig. 3 e Histopathological image shows epitheloid granuloma of tuberculosis. a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e22 Please cite this article in press as: Khanna V, et al., Spina ventosa in an 18 year old, Apollo Medicine (2014), http://dx.doi.org/ 10.1016/j.apme.2014.07.001
  4. 4. Apollohospitals:http://www.apollohospitals.com/ Twitter:https://twitter.com/HospitalsApollo Youtube:http://www.youtube.com/apollohospitalsindia Facebook:http://www.facebook.com/TheApolloHospitals Slideshare:http://www.slideshare.net/Apollo_Hospitals Linkedin:http://www.linkedin.com/company/apollo-hospitals Blog:Blog:http://www.letstalkhealth.in/

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