Spina ventosa

Case contributed by Dr Henry Knipe

Presentation

Two weeks of painless swelling of the left hand. No history of trauma.

Patient Data

Age: 30 years
Gender: Male
Modality: X-ray

Sclerosis with periosteal reaction of the 2nd metacarpal. Associated marked soft tissue swelling. No joint destruction. 

Modality: MRI

Diffuse marrow infiltration of the second metacarpal with cortical destruction and periosteal reaction. There is an intraosseous abscess with adjacent peripherally enhancing collection. 

Modality: X-ray

Large left-sided pleural effusion with compressive collapse of the left lower lobe. Nodule noted within the right upper zone.

Modality: CT

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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Case Information

rID: 42825
Case created: 9th Feb 2016
Last edited: 7th Dec 2016
Inclusion in quiz mode: Included

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