This case report describes a 56-year-old man who presented with an 8-month history of painful swelling in his right thumb. Imaging showed extensive destruction of the proximal phalanx bone and soft tissue swelling. Biopsy revealed granulomatous inflammation and acid-fast bacilli, leading to a diagnosis of tuberculous dactylitis. The patient underwent surgical debridement and 6 months of anti-tuberculosis treatment. At a 7-year follow-up, the thumb was shortened but he had good hand function with no significant disability.
Primary hydatidosis of the tibia is a rare disease. In an endemic area, it should be considered in the differential diagnosis of a
hypolucent osteolytic lesion on x-ray. If not properly managed, anaphylactic shock may occur intraoperatively, as well as increased recurrence of the disease. This is a case report of a primary tibial hydatid cyst, treated fi rst with curettage and phenolizaton, and then after recurrence, with total knee arthroplasty. We will review the literature of the diagnosis and the treatment of a tibial hydatid cyst.
Traditionally, obtaining tissue diagnosis from the Temporomandibular Joint (TMJ) has required invasive open techniques. In this case-series, the authors demonstrate a minimally invasive technique using arthroscopy to diagnose and treat Pigmented Villonodular Synovitis (PVNS) and pseudogout of the TMJ, followed by a review of the literature.
Multiple Giant Cell Tumours of Tendon Sheath of Thumb: A Rare Case Reportiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Primary hydatidosis of the tibia is a rare disease. In an endemic area, it should be considered in the differential diagnosis of a
hypolucent osteolytic lesion on x-ray. If not properly managed, anaphylactic shock may occur intraoperatively, as well as increased recurrence of the disease. This is a case report of a primary tibial hydatid cyst, treated fi rst with curettage and phenolizaton, and then after recurrence, with total knee arthroplasty. We will review the literature of the diagnosis and the treatment of a tibial hydatid cyst.
Traditionally, obtaining tissue diagnosis from the Temporomandibular Joint (TMJ) has required invasive open techniques. In this case-series, the authors demonstrate a minimally invasive technique using arthroscopy to diagnose and treat Pigmented Villonodular Synovitis (PVNS) and pseudogout of the TMJ, followed by a review of the literature.
Multiple Giant Cell Tumours of Tendon Sheath of Thumb: A Rare Case Reportiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A 10 year old boy presented with fever, local swelling around the ankle with tenderness and antalgic gait, without any antecedent trauma or discharging sinus. He had no evidence of pulmonary tuberculosis. Laboratory tests revealed signs of inflammation with normal Mantoux test and chest X-ray. An irregular lytic lesion of the talus was seen on the x-ray of the affected part. Ziehl Nelson staining of the aspirated fluid revealed acid-fast bacilli. Material obtained after curettage and bone grafting confirmed the diagnosis of tuberculosis. He was treated conservatively with splintage and 4 drug anti-tubercular chemotherapy for 18 months, without any residual tenderness or foot deformity at the final follow-up. This case has been reported because of its rarity and atypical clinical presentation.
Introduction: Spontaneous Osteonecrosis of the Knee (SONK) is a devastating and debilitating disease that mainly affl icts the
elderly. A conservative approach may forgo the need for surgical intervention. This case report describes an orthopaedic patient diagnosed with SONK. After fi ve months of conservative treatment, the patient was able to walk without pain and remained clinically stable for seven years.
Case Presentation: A 49-year-old male patient diagnosed with SONK of the left knee elected to undergo conservative management in lieu of surgical intervention. Seven years later the patient’s symptoms and MRI demonstrate a dramatic improvement.
Journal of Pathology & Microbiology is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Pathology & Microbiology.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Pathology & Microbiology. Journal of Pathology & Microbiology accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of pathology & microbiology.
Journal of Pathology & Microbiology strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Unusual Presentation of Tuberculosis in Head and Neck RegionSachender Tanwar
Abstract: 3 case reports of tuberculosis at uncommon sites within head and neck region. Diagnosed on the basis of various clinical,
histopathological and imaging studies. Managed either with DOTS regimen only or both surgery & antitubercular treatment. None of
the cases showed non-compliance to treatment or recurrence of disease.
Keywords: tuberculosis, intra parotid lymphadenitis, branchial cyst, jugular chain lymphadenitis level II-III.
Chondroblastic osteosarcoma of the left zygomatic bone rare case report and ...Prashant Munde
Chondroblastic osteosarcoma (COS), a subgroup of intramedullary
osteosarcoma (OS), is the most common osteosarcoma that occurs in
adolescents and early adulthood. The COS has similar clinical and radiological
features to those of conventional OS. We present a case of 20‑year‑old male
patient with the chief complaint of pain and swelling in the left zygomatic region.
The computed tomography (CT) and three‑dimensional (3D) CT face showed
erosion, calcific foci, sunray type of spicules suggestive of OS. On fine‑needle
aspiration cytology (FNAC) examination, initial diagnosis was malignant
chondroid lesion, with differential diagnosis of mesenchymal chrondrosarcoma,
COS on incisional biopsy and finally COS on excisional biopsy. The patient
underwent radical resection of left zygomatic arch, followed by chemotherapy.
Although clinically unsuspected in this unusual site, histopathology along with
immunohistochemistry (IHC) results confirmed the COS. Because zygomatic
location of COS is very rare, this report aimed to discuss clinical, radiographic,
histopathologic, IHC findings and diagnostic pitfalls of COS in light of the
literature.
A 10 year old boy presented with fever, local swelling around the ankle with tenderness and antalgic gait, without any antecedent trauma or discharging sinus. He had no evidence of pulmonary tuberculosis. Laboratory tests revealed signs of inflammation with normal Mantoux test and chest X-ray. An irregular lytic lesion of the talus was seen on the x-ray of the affected part. Ziehl Nelson staining of the aspirated fluid revealed acid-fast bacilli. Material obtained after curettage and bone grafting confirmed the diagnosis of tuberculosis. He was treated conservatively with splintage and 4 drug anti-tubercular chemotherapy for 18 months, without any residual tenderness or foot deformity at the final follow-up. This case has been reported because of its rarity and atypical clinical presentation.
Introduction: Spontaneous Osteonecrosis of the Knee (SONK) is a devastating and debilitating disease that mainly affl icts the
elderly. A conservative approach may forgo the need for surgical intervention. This case report describes an orthopaedic patient diagnosed with SONK. After fi ve months of conservative treatment, the patient was able to walk without pain and remained clinically stable for seven years.
Case Presentation: A 49-year-old male patient diagnosed with SONK of the left knee elected to undergo conservative management in lieu of surgical intervention. Seven years later the patient’s symptoms and MRI demonstrate a dramatic improvement.
Journal of Pathology & Microbiology is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Pathology & Microbiology.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Pathology & Microbiology. Journal of Pathology & Microbiology accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of pathology & microbiology.
Journal of Pathology & Microbiology strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Unusual Presentation of Tuberculosis in Head and Neck RegionSachender Tanwar
Abstract: 3 case reports of tuberculosis at uncommon sites within head and neck region. Diagnosed on the basis of various clinical,
histopathological and imaging studies. Managed either with DOTS regimen only or both surgery & antitubercular treatment. None of
the cases showed non-compliance to treatment or recurrence of disease.
Keywords: tuberculosis, intra parotid lymphadenitis, branchial cyst, jugular chain lymphadenitis level II-III.
Chondroblastic osteosarcoma of the left zygomatic bone rare case report and ...Prashant Munde
Chondroblastic osteosarcoma (COS), a subgroup of intramedullary
osteosarcoma (OS), is the most common osteosarcoma that occurs in
adolescents and early adulthood. The COS has similar clinical and radiological
features to those of conventional OS. We present a case of 20‑year‑old male
patient with the chief complaint of pain and swelling in the left zygomatic region.
The computed tomography (CT) and three‑dimensional (3D) CT face showed
erosion, calcific foci, sunray type of spicules suggestive of OS. On fine‑needle
aspiration cytology (FNAC) examination, initial diagnosis was malignant
chondroid lesion, with differential diagnosis of mesenchymal chrondrosarcoma,
COS on incisional biopsy and finally COS on excisional biopsy. The patient
underwent radical resection of left zygomatic arch, followed by chemotherapy.
Although clinically unsuspected in this unusual site, histopathology along with
immunohistochemistry (IHC) results confirmed the COS. Because zygomatic
location of COS is very rare, this report aimed to discuss clinical, radiographic,
histopathologic, IHC findings and diagnostic pitfalls of COS in light of the
literature.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
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ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
Tuberculous dactylitis pseudotumor of an adult thumb.pdf
1. CASE REPORT
Tuberculous dactylitis pseudotumor of an adult thumb:
a case report
Freih Odeh Abu Hassan
Received: 23 November 2008 / Accepted: 20 January 2010 / Published online: 12 February 2010
Ó Springer-Verlag 2010
Abstract Tuberculous dactylitis is an uncommon condi-
tion which is particularly difficult to differentiate from
other lesions, particularly tumors. We report the case of a
56-year-old, healthy, left-handed person who consulted for
progressive painful swelling of 8-month duration in the
right thumb, which had developed after direct trauma. The
plain radiograph of the thumb revealed extensive destruc-
tion of the proximal phalanx associated with pathological
fracture. Magnetic resonance imaging (MRI) showed
replacement of the affected phalanx with prominent soft
tissue mass with extension outside the bone margins. The
diagnosis of tuberculous dactylitis was based on histolog-
ical characteristics and positive acid fast bacilli using
Ziehl-Neelsen stain. Surgical debridement and anti-tuber-
culous chemotherapy eradicated the infection. Seven years
post treatment, the patient had good function of the thumb
with no significant disability interfering with his daily
activity.
Keywords Dactylitis Tuberculosis Granuloma
Pseudotumor
Introduction
It is of historic interest that Feilchenfeld in 1896 described
tuberculous dactylitis roentgenographically in children, and
Rankin in 1886 identified tuberculous dactylitis by histo-
logical technique [1].
Tuberculous involvement of the small bones of the
hand is a rare presentation of extra pulmonary tuberculosis
[2–4].
The spine is the most frequent site of skeletal involve-
ment; occurring in less than 3% of patients with extra
pulmonary tuberculosis [5, 6].
The many non-specific manifestations of extra pul-
monary tuberculosis can cause a considerable diagnostic
delay, which may be further extended, because tuberculosis
as a whole has become rare and is thus easily overlooked
[3, 4].
Tuberculous dactylitis is often referred to as spina
ventosa, which is a descriptive term referring to any bone
lesion that causes progressive absorption of cortex bor-
dering the medullary canal with progressive subperiosteal
hyperplasia until roentgenographically the bone appears
inflated and destructed [1, 7].
We describe a healthy adult patient who had tuberculous
dactylitis of the proximal phalanx of the thumb and
tuberculous axillary lymphadenitis associated with patho-
logical fracture.
Case report
A 56-year-old healthy male patient presented to the out-
patient department with a history of painful swelling of
8-month duration in the right thumb.
He gave a history of direct trauma to the right thumb
few weeks prior the onset of the swelling, but he denied
any history of contact with tuberculosis patients or pul-
monary symptoms and had no treatment with antitubercular
agents.
F. O. A. Hassan ()
The Department of Orthopaedic Surgery,
Jordan University Hospital, PO Box 73, Jubaiha,
Amman 11941, Jordan
e-mail: freih@ju.edu.jo
123
Strat Traum Limb Recon (2010) 5:53–56
DOI 10.1007/s11751-010-0080-1
2. Physical examination revealed concentric swelling of
the right thumb measuring 4 9 3 9 3 cm, and deformity
of thumb, which was slightly tender on palpation. There
was restricted movement at all joints of the thumb.
Prominent enlargement of the right axillary lymph nodes
was also demonstrated. Blood tests showed normal eryth-
rocyte sedimentation rate (15 mm 1st h) and normal white
cell count (4.3 9 103
/mm3
). Radiographs of the thumb
showed soft tissue swelling, extensive destruction of the
proximal phalanx with subluxation of interphalangeal joint
and pathological fracture (Fig. 1). A differential diagnosis
of tumor or an infection was considered. A 99mTc HDP
bone scan revealed increased uptake at all three phases at
the joints of the right thumb and proximal phalanx.
Magnetic resonance imaging (MRI) showed on T2-
weighted MR images, expansion of the marrow cavity of
the affected phalanx, filled with heterogeneous signal
intensity, consisting of a peripheral portion of higher signal
intensity and a central portion of relatively low signal
intensity (Fig. 2). The lesion extended to the soft tissue
through the destructed margins of all sides of the phalanx,
with hyperintensity noted in the subcutaneous tissue and
around the tendons. On T1-weighted images, the same
region showed intermediate to low signal intensity.
Magnetic resonance imaging (MRI) of the right axilla
showed multiple enlarged axillary lymph nodes (Fig. 3).
Computerized axial scan of the thorax and abdomen did
not show any primary focus of infection.
One week after complete investigations, an open biopsy
was taken from the right thumb and the right axillary lymph
nodes which did show necrotic like tissue. Microscopy
revealed no evidence of malignancy, but granulomatous
reaction with central caseous necrosis and Langhans type
giant cells destroying bone trabeculae. The biopsy from
axillary lymph nodes revealed replacement of the node
architecture by multiple granulomas showing central
necrosis. Acid fast bacilli identified by the Ziehl-Neelsen
technique in the specimen culture were taken for histopa-
thological examination after 4 weeks. One week after the
confirmation of the diagnosis, surgical debridement of the
granulomatous tissue at the distal 3/4 of the proximal pha-
lanx was performed two weeks after the biopsy. A Kirsch-
ner wire was inserted to stabilize the phalanx for 6 weeks.
In the immediate postoperative period, the patient was
started on antituberculous combination of ethambutol,
isoniazid and rifampicin for 6 months. Patient was fol-
lowed up weekly for the first month then monthly for
5 months then annually till the final follow-up. Seven years
post treatment, the thumb appeared short and flexion
(Fig. 4). Hand has good grip function with no significant
disability (Fig. 5). Plain radiograph of the thumb confirmed
healing of the disease with only remnant proximal part of
the phalanx (Fig. 6).
Fig. 1 Plain radiograph of the right thumb showing extensive
destruction of the proximal phalanx with subluxation of interphalan-
geal joint and pathological fracture
Fig. 2 T2-weighted MR images, showing expansion of the affected
phalanx, filled with heterogeneous signal intensity
54 Strat Traum Limb Recon (2010) 5:53–56
123
3. Discussion
Bone and joint Tuberculosis occurs in 1–3% children who
have untreated initial pulmonary tuberculosis [4, 5].
Tuberculous dactylitis runs a protracted chronic course,
symptom duration ranged from a few months to 2 or
3 years after the initial infection [4, 5, 8]. Eighty-five per
cent of patients with extra pulmonary tuberculosis are
younger than 6 years of age, and its incidence among
children with tuberculosis is reported to be 0.65–8% [6, 7].
Almost 50% of such cases had peripheral lymphadenopathy
[9]. This was noticed in our case. In adults, extra pul-
monary tuberculosis occurs between the ages of 20 and 50
[2, 3]. The bones of the hands are more frequently affected
than bones of the feet, with the proximal phalanx of the
index and middle fingers the commonest sites for infection
[2–4]. This is contrary to our case which occurred in the
thumb. The radiographic features of cystic expansion of the
short tubular bones have led to the name of ‘‘spina ven-
tosa’’ being given to tuberculous dactylitis of the short
Fig. 3 Magnetic resonance imaging (MRI) of the right axilla
showing multiple enlarged axillary lymph nodes
Fig. 4 Clinical appearance of the thumb at latest follow up
Fig. 5 Functional appearance of the hand
Fig. 6 Plain radiograph of the thumb confirmed healing of the
disease with only remnant proximal part of the phalanx
Strat Traum Limb Recon (2010) 5:53–56 55
123
4. bones of the hand [1, 7] which was noticed in our case.
Periosteal reactions, sequestra and sclerosis are not com-
mon features [5, 10, 11]. Neither of these findings was
noticed in our case. None of the well-known risk factors for
tuberculosis e.g. socioeconomic deprivation, migration and
immunodepression [4, 12] were noticed in our patient.
Classically, tuberculous dactylitis involves the flexor
tendon sheaths and spares the joint synovium and bone in
adults [13]. Our case involves both the joint and the bones
with the picture of spina ventosa that peculiar to children.
The definite diagnosis of tuberculous dactylitis rests on
bacteriological and histological studies. The differential
diagnosis of tuberculous dactylitis includes osteomyelitis,
metabolic diseases (gout), sarcoidosis, and tumors [3, 14].
Infection is rapidly responsible for bone destruction, but
the rate of lesion progression is far slower with mycobac-
teria [10]. In sarcoidosis, well-demarcated cystic lesions
are found in the phalanges of the fingers, although bony
expansion and periosteal new bone formation are not found
[10, 14]. In enchondromatosis, numerous lesions are pres-
ent and the characteristics of punctate calcification [3, 14].
Other even more uncommon causes of lesions simulat-
ing dactylitis are hemoglobinopathies, hyperparathyroid-
ism, and leukemia [15]. Although rare, tuberculous
dactylitis must be kept in mind and needs continued vigi-
lance when dealing with a lytic expansile lesion that
involves a phalanx. Radiographic features of tuberculosis
of small bones may not be recognized immediately.
Despite the unusual presentation of our case in that both the
joint and the small tubular bone of the thumb are nearly
totally destructed with the picture of spina ventosa that
peculiar to children rather than adults, eradication of
infection can be performed by surgical debridement and
antituberculous medications.
References
1. Pearlman HS, Warren RF (1961) Tuberculous dactylitis. Am J
Surg 101:769–771
2. Leung PC (1978) Tuberculosis of the hand. The Hand 10(3):285–
291
3. Jensen CM, Jensen CH, Paerregaard A (1991) A diagnostic
problem in tuberculous dactylitis. J Hand Surg Br 16(2):202–203
4. Subasi M, Bukte Y, Kapukaya A, Gurkan F (2004) Tuberculosis
of the metacarpals and phalanges of the hand. Ann Plast Surg
53(5):469–472
5. Coombs R, Fitzgerald RH (1989) Infection in the orthopaedic
patient, 1st edn. Butterworth Co Ltd, Great Britain, pp 297–
298
6. Agarwal S, Caplivski D, Bottone EJ (2005) Disseminated
tuberculosis presenting with finger swelling in a patient with
tuberculous osteomyelitis: a case report. Ann Clin Microbiol
Antimicrob 4:18. doi:10.1186/1476-0711-4-18
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