Its clinical diagnosis is often delayed as local symptoms may easily be missed in children and constitutional features such as loss of weight, loss of appetite, night sweats, evening rise of temperature and history of close contact with a patient of tuberculosis may not always be present. Robot hand nursing board college board pictures brainstorm weed cases fantasy signs. The bones of the hands are more affected than the bones of the feet. Tuberculous dactylitis in a 20 year old a rare case report. Spina ventosa is another name given to tuberculous dactylitis, and is a relatively uncommon manifestation of tuberculosis. Spina ventosa is the term given for tuberculous dactylitis. Any delay in diagnosis and treatment of tuberculosis dactylitis is likely to decrease the chances of good functional outcome. Imaging of extrapulmonary tuberculosis radiographics.
If feasible, a biopsy is recommended to establish the diagnosis. A 9 year old male presented with a two year history of a painless mass overlying the fourth finger of the right hand. This appearance is termed spina ventosa windfilled sail, 4,, fig 6. Tubercular dactylitis spina ventosa a clinical diagnosis. The authors report two cases, one of tuberculous dactylitis in a 55yearold male and another of. Periosteal reaction and sequestra are not common but may occur. A cystlike cavity due to the destruction of the underlying bone and ballooning out of the remaining bone gives the appearance termed spina ventosa windfilled sail. Tuberculous dactylitis radiology reference article.
Tuberculous dactylitis, also known as spina ventosa, is a rare skeletal manifestation of tuberculosis where the short tubular bones i. Tuberculous dactylitis spina ventosa with concomitant. Our 50yearold patient presented with spontaneous and insidious finger swelling, fever and night sweats of 7 months. Arthritis tubercle bacilli are deposited in the synovium via a hematogenous route, but may also gain access through. Spina ventosatuberculous dactylitis archives of disease in. We report the case of a fifteenyearold adolescent boy who was diagnosed with tuberculous dactylitis, involving contralateral hand and foot. Tubercular dactylitis td is a tubercular infection of the short tubular bones of the hands and feet. Up to nearly 7% of children with pulmonary tuberculosis may. Tuberculous dactylitis is most common in children, and four radiographic forms have been described, the most common of which involves a spindleshape expansion of a phalanx spina ventosa25. Cystic expansion leads to formation of spina ventosa spinaspinelike projections. Tuberculous dactylitis or spina yentosa is usually a disease of infancy and childhood.
Tuberculosis is an infectious disease caused by mycobacterium tuberculosis and manifested by formation of granulomas associated with caseous necrosis in tissues. Tuberculous dactylitis spina ventosa with concomitant ipsilateral. Spina ventosa with lupus vulgaris and lymphadenopathy. Lupus vulgaris is one of the common forms of cutaneous tuberculosis. Spina ventosa discharging tubercle bacillia case report. It is mainly caused by hematogenous spread from the lungs. Proximal phalanx of the index and middle fingers are the commonest sites of involvement. Tuberculous dactylitis involving the short tubular bones of the hands and feet occurs especially frequently in children. Figure 3 is a radiographofthe right and left hands ofthe child in figure 1. Pdf spina ventosatuberculous dactylitis researchgate. Neither child had signs or symptoms ofsystemic illness. Differentials include infections pyogenic osteomyelitis, tuberculosis, phaeohyphomycosis, psa, sarcoidosis, reactive arthritis, gout and bone tumours.
Tuberculous dactylitis is often referred to as spina ventosa. A chest radiograph showed right upper lobe airspace disease with associated hilar adenopathy consistent with pulmonary tuberculosis tb. Osteoarticular tuberculosis involving short tubular bones of hands and feet such as metacarpals. Epidemiology tuberculous osteitis is one of the commone. Bone and joint tuberculosis constitute 1%3% of extrapulmonary tb.
Pejman salimpour,md two children, both 2 years of age, were seen with indolent swelling of the fin gers figure 1 and figure 2. Bone and joint tuberculosis occur in 15% children who have untreated initial pulmonary tuberculosis and spread to the skeletal system during the initial infection via the lymphohaematogenous route. Introduction tuberculous infection of metacarpals, metatarsals and phalanges of hands and feet is known as tuberculous dactylitis 1. Tuberculous dactylitis presenting as a pathological. It has a predilection for the proximal phalanx of index and middle fingers. Even rarer is the association of tuberculous dactylitis with multifocal skeletal involvement, even in countries like ours, where tuberculosis is endemic. Tuberculous dactylitis pseudotumor of an adult thumb. Dactylitis or sausage digit is an inflammatory fusiform digital swelling. Scrofuloderma is a mycobacterial infection affecting children and young adults, representing direct extension of tuberculosis into the skin from underlying structures e. Tuberculous infection of metacarpals, metatarsals and phalanges is known as tuberculous dactylitis.
Dactylitis, granuloma, spina ventosa, tuberculosis introduction. A diffuse infiltration with a lytic honeycomb appearance, as seen in our case, is less frequent. The condition usually presents as a painless swelling of a digit of a few months duration. Tuberculous dactylitis spina ventosa is a rare extrapulmonary manifestation with incidence of 0. Radiological and clinical presentation of tuberculous dactylitis creates confusion in diagnosis and delays treatment, which could lead to progressive joint. The term spina ventosa has been used to describe this disorder because of its radiographic features of cystic expansion of the involved short tubular bones. Tubercular dactylitis in a young boy the journal of pediatrics. Patel nc, brogdon bg, srinath mg, adekal a 2000 tuberculosis dactylitis spina ventosa secondary to pulmonary tuberculosis. Histopathological examination report confirmed it as spina ventosa. Dactylitis occurs in 30% to 40% of patients during the course of their disease. Healing with nonoperative treatment is excellent provided the diagnosis is made when tuberculosis presents with soft tissue swelling alone and before bony destruction.
We present a case of 20 year old female with an isolated swelling in the right thumb of 3 months duration. The bones of hands are more commonly involved than those of the feet. His diagnosis was delayed due to lack of suspicion of this rare entity. The previously described different radiological entities of tubercular osteomyelitis of metacarpals and phalanges appear to be a sequential manifestation of the disease spectrum. Up to nearly 7% of children with pulmonary tuberculosis may develop this condition. Spina ventosa, a spindle shaped expansion with multiple layers of subperiostial new bone, occurs in the short tubular bones of the hands and feet fig. Tuberculous dactylitis is an uncommon form of extrapulmonary tuberculosis involving the small bones of the hand or the foot. The skeletal infection becomes symptomatic within years after the initial infection. Spina ventosa is tubercular osteomyelitis of the phalanges that can spread to overlying soft tissues causing sausage digit. Musculoskeletal tuberculosis tb is a rare manifestation of tb comprising 1%3% of all cases. Introduction tuberculous infection of metacarpals, metatarsals and phalanges of hands and. Tuberculous dactylitis is often referred to as spina ventosa, which is a descriptive term referring to any bone lesion that causes progressive absorption of cortex bor.
Spina ventosa discharging tubercle bacillia case report indian j tuberc 2009. Tuberculosis of the short tubular bones like phalanges, metacarpals or metatarsals is quite uncommon beyond 6 years of age, once the epiphyseal centers are well established. A helpful feature in distinguishing tuberculous from pyogenic infection is that transphyseal spread occurs in the former. Tubercular dactylitis spina ventosa a 17yearold male presented with a painful swelling of the middle phalanx of the right middle finger of 3 weeks duration. Of note was that he had been started on antituberculous treatment two weeks prior to presentation. This disease is uncommonly seen in children over 5 years of age. Tubercular dactylitis is a rare manifestation of skeletal tuberculosis in the paediatric population. In the musculoskeletal system, tuberculous spondylitis is the most typical. Tuberculosis dactylitis, spina ventosa, tuberculous granuloma 1. Homevolume 4, issue 4 octoberdecember, 2014 tuberculous dactylitis. He had mild fever and restriction of motion of the affected finger. Tuberculosis tb is the second most common cause of skeletal infection in the developing world. Tuberculous dactylitis, tuberculous granuloma, spina ventosa, spindle shaped expansion.
This form of osteoarthritic tuberculosis is extremely rare. The radiographic features of cystic expansion have led to the name spina ventosa for tuberculous dactylitis of the short bones. Nearly 85% of the patients of spina ventosa are below 6 years of age. Google and medline search was done using key words tuberculous dactylitis and spina ventosa. Tuberculous dactylitis, a form of tuberculous osteomyelitis. Pdf tuberculous dactylitis spina ventosa with concomitant. Spina ventosaa rare cause of sausage digit rheumatology. Herzfeld and tod 1 found 97 cases of the condition in 1,403 tuberculous children, thus representing 6 per cent of all cases of surgical tuberculosis. Involvement of small bones of hand and feet leading to tuberculous dactylitis involvement is a rare presentation of extrapulmonary tuberculosis. Tuberculous dactylitis, spina ventosa, expansile lytic lesion, tuberculosis introduction tuberculous dactylitis is an uncommon form of extrapulmonary tuberculosis involving the small bones of the hand or the foot. We describe a patient who had multiple manifestations of skeletal tb, including spondylitis, dactylitis, and poncets disease.
The literature on tuberculous dactylitis is poor, and most literature consists of isolated case reports. Tuberculous dactylitis spina ventosa of proximal phalanx in. Feroz alam, noora saeed, aaliya ehsan, asim israr khan. It is notable that the patient described in our dactylitis spina ventosa secondary to pulmonary tuberculosis. Pdf tuberculous dactylitis is a distinctly uncommon, yet well recognized form of tuberculosis involving the small bones of the hand or foot. Tuberculous dactylitis presenting as a pathological fracture a case report. The absence of sequestration and the presence of diffuse osteopenia distinguish tuberculous infection from pyogenic infection.
Tuberculous dactylitisan easily missed diagnosis core. Tuberculous osteomyelitis can be mimicked by pyogenic or fungal infections. The radiographic feature of cystic expansion of short tubular bones has led to the name of spina ventosa being given to tuberculosis dactylitis of the short bones of the hand 3 gyanshankar pm, dhamgaye tm, amol bf. Tuberculous dactylitis or spina ventosa is a rare skeletal mani festation of tuberculosis in young children that commonly in volves the short tubular bones of the. A rare presentation of skeletal tuberculosis article pdf available. Laboratorys inflammation, virus, rf and brucella tests. Tuberculous dactylitis is quite uncommon beyond 6 years of age after the formation of the epiphyseal centers.
The radiographic feature of cystic expansion of short tubular bones has led to the name of spina ventosa being given to tuberculosis dactylitis of the short bones of the hand 3, 4. Tuberculous dactylitis is an unusual form of osteoarticular tuberculosis involving the short tubular bones of hands and feet, which is uncommon beyond six years of age. Introduction tubercular dactylitis is tuberculous infection of metatarsals, metacarpals and phalanges of hands and feet. Tuberculous dactylitis, a form of tuberculous osteomyelitis, is well recognised in countries with a high prevalence of. Tuberculous dactylitisan easily missed diagnosis n. Skeletal involvement accounts 15% of all cases of tuberculosis.
Tuberculous dactylitis is a rare extrapulmonary manifestation common in children. The aim of this case series is to study the particularities and the epidemiological aspects of tuberculous dactylitis in tunisian patients. Spina ventosa is a descriptive term, referring to any bone lesion that causes progressive absorption of cortex bordering the medullary canal with progressive subperiosteal hyperplasia, until, roentgenographically, the bone appears inflated. Tuberculous dactylitis spina ventosa with concomitant ipsilateral axillary scrofuloderma in an immunocompetent child. Gyanshankar pm, dhamgaye tm, amol bf 2009 spina ventosa discharging tubercle bacillia case report. A 17yearold male presented with a painful swelling of the middle phalanx of the right middle finger of 3 weeks duration. There is a spindle shaped expansion of the short tubular bones due to tuberculous granuloma. Spina ventosa tuberculous dactylitis in a 2 year old.
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