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Tuberculosis dactylitis

Tuberculous dactylitis (also known as spina ventosa) is a skeletal manifestation of tuberculosis.

Epidemiology

Tuberculous osteietis is one of the commonest bacterial osteitis. Typically the dactylitis form affects paediatric age group more often than adults.  In children multiple or consecutive bones are involved, compared to a single bone in adults.4

Clinical presentation

Tuberculous dactylitis involves the short tubular bones of the hands and feet in children. It often follows a benign course without pyrexia and acute inflammatory signs as opposed to acute osteomyelitis.

Radiographic features

Plain film

Plain Radiography is the modality of choice for evaluation and follow up.

Tends to affect the bones distal to tarsus and wrist, upper limb being more commonly involved. Typically the proximal phalanx of the index/middle fingers and middle/ring finger metacarpals are affected.

  • involved bone shows a diaphyseal expansile lesion
  • a periosteal reaction is uncommon
  • healing is by sclerosis and is usually gradual

Etymology

This condition was first described by Boyer and Nelaton.

The term spina ventosa derives from spina = short bone and ventosa = expanded with air.

Differential diagnosis

The differential diagnosis includes:

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