A painful finger—answer: Dieterich’s disease

Excerpt

The x-ray of the hand revealed an irregular trabecular pattern, sclerosis of the subchondral bone, and collapse of the head of the second metacarpal (Fig. 1). A follow-up CT scan showed a collapse of the articular surface, resulting in a 7-mm defect on the distal end of the metacarpal head, along with subchondral sclerosis. These findings matched those seen on the x-ray (Fig. 2). Finally, an MRI was performed. The patient refused to undergo a contrast-enhanced MRI, limiting the sequences acquired to those without gadolinium enhancement. The bone signal around the lesion was hypointense in T1-weighted and T1-weighted imaging with fat saturation (Fig. 3). The bone adjacent to the lesion, on proton density-weighted imaging with fat saturation (Fig. 4) and T2-weighted imaging with fat-saturation, revealed a slightly hyperintensity (Fig. 5). These findings are consistent with bone oedema. …