11 Erosion of Multiple Terminal Phalangeal Tufts (Acro-

Osteolysis)

CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSIS

EISENBERG

DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

• Fig B 11-1 Raynaud's disease. Severe trophic changes involve the distal phalanges with resorption of the terminal tufts.

• Fig B 11-2 Diabetic gangrene. Diffuse destruction of the phalanges and the metatarsal head of the fifth digit. Note the large amount of gas in the soft tissues of the foot.

• Fig B 11-3 Psoriatic arthritis. Arthritis mutilans of the foot and ankle. Severe pencil-like destruction of the metatarsals and phalanges with ankylosis of almost all the tarsal joints.

• Fig B 11-4 Leprosy. Severe phalangeal resorption with evidence of typical pencil-like configurations.

• Fig B 11-5 Hyperparathyroidism. Tuft resorption associated with subperiosteal bone resorption that predominantly involves the radial margins of the middle phalanges of the second, third, and fourth digits (arrows).

• Fig B 11-6 Lesch-Nyhan syndrome. Amputation of the index and middle fingers from a self-inflicted bite. Although the child is 5 years old, the bone age is that of a 3-year-old.24

• Fig B 11-7 Epidermolysis bullosa. Diffuse trophic changes about the distal phalanges associated with bilateral contracture deformities resulting in a claw hand. Note the peculiar pointed, hook-like appearance of the terminal phalanges of the thumbs.25

Fig B 11-8 Progeria. Progressive absorption of the ungual tufts with preservation of soft tissues occurring over a 5-year period.26

Fig B 11-9 Familial acro-osteolysis. Characteristic band-like areas of lucency crossing the waists of several phalanges.

• Fig B 11-10 Pachydermoperiostosis. Elephant-like thickening of the skin causes clubbing of the distal fingers and exaggerated knuckle pads in addition to a generalized increase in the bulk of the soft tissues surrounding the phalanges. Loss of the tufts accompanies the increase in the overlying soft tissues.19