Presentation
Two weeks of painless swelling of the left hand. No history of trauma.
Patient Data
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Sclerosis with periosteal reaction of the 2nd metacarpal. Associated marked soft tissue swelling. No joint destruction.
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Diffuse marrow infiltration of the second metacarpal with cortical destruction and periosteal reaction. There is an intraosseous abscess with adjacent peripherally enhancing collection.
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Large left-sided pleural effusion with compressive collapse of the left lower lobe. Nodule noted within the right upper zone.
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Left lower lobe compressive collapse/consolidation in addition to segmental left upper lobe collapse/consolidation. This is on a background of innumerable sub-5 mm bilateral pulmonary nodules predominantly in the upper lobes. No cavitation or calcification. Large left pleural effusion. Enlarged mediastinal lymph nodes.
The patient underwent left pleural tap and pleural biopsy with a weakly positive pleural fluid PCR for tuberculosis. The hand was not aspirated/biopsied in the view of these results and the patient was commenced treatment for tuberculosis (also in the context of emigrating from a TB-endemic country three years earlier).
Case Discussion
Spina ventosa is another name given to tuberculous dactylitis, and is a relatively uncommon manifestation of tuberculosis.
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