Sunday, May 6, 2012

Acro-osteolysis: Differential Diagnosis #8

Acro-osteolysis can be understood by breaking down its components: acro refers to the digits, osteo refers to the bone, and lysis means to break down. In other words, terminal tuft erosions. While not very common, there is a differential for this. I like to think of it as when you see the bony finger tips being PINCH(ed) OF:

PPyknodysostosisassociated with osteosclerosis and Wormian bones
IInjury (thermal)
NNeuropathicdiabetes, leprosy
CCollagen vascular diseasescleroderma, Raynaud's phenomenon
HHyperparathyroidismcalcium, resorption

OOtherProgeria, Polyvinyl chloride exposure
FFamilialHadju-Cheney disease

Hyperparathyroid Hands
Source: Radiopaedia
Note how the terminal tufts appear in the image above. They should be more uniform without the erosions seen in the image above.