Spade phalanx sign (acromegaly)

Last revised by Dr Mostafa El-Feky on 23 Feb 2020

Spade phalanx sign refers to a characteristic distal phalangeal shape in acromegaly.

Radiographic features

Plain radiographs

The terminal phalangeal tufts become hypertrophied and have a "spade appearance".

Other findings on hand radiography of acromegaly include

  • joint spaces may be minimally enlarged
  • premature osteoarthritis may occur

Differential diagnosis

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Cases and figures

  • Case 1: normal variant
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  • Case 2: acromegaly
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  • Case 2: acromegaly
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