Tuberculous dactylitis

Tuberculous dactylitis, also known as spina ventosa, is a rare skeletal manifestation of tuberculosis where the short tubular bones (i.e. phalanges, metacarpals, metatarsals) are affected.

Epidemiology

Tuberculous osteitis 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 radiograph

Plain radiography is the modality of choice for evaluation and follow-up. The bones distal to tarsus and wrist tend to be affected, with the upper limb being more commonly involved. Typically the proximal phalanx of the index/middle fingers and middle/ring finger metacarpals are affected. Characteristic features include:

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

History and etymology

Boyer and Nelaton first described this condition.

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

Differential diagnosis

The differential diagnosis includes:

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