Woman investigated for bilateral hand pains.
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Hand radiographs demonstate abnormality of the bilateral 3rd and right 2nd metacarpal heads. There is contour deformity of the heads and a mixed lucent and sclerotic appearance to the subchondral bone. These findings are consistent with avascular necrosis which in this location has the eponymous name: dietrich disease.
There is possible erosion of the right ulnar styloid process and therefore a superimposed erosive arthropathy such as rheumatoid arthritis needs consideration.