Spina Ventosa

Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160 012,
E-mail: [email protected]
 

A 7-year old boy presented with a painless swelling associated with serosanguinous discharge in the left ring finger for 1
month. He also had cough and fever which was not documented. He had received multiple courses of antibiotics before coming to us. On examination, a non-tender, fusiform swelling of the left ring finger discharging serosanguinous fluid was seen (Fig.1). X-ray revealed a lytic lesion with little periosteal reaction in the middle phalanx (Fig.2). X-ray chest revealed bilateral heterogenous opacities and hilar and paratracheal lymphadenopathy. The Zeil–Neilson staining of the discharge from the swelling demonstrated acid fast bacilli.

Fig. 1 Spindle shaped swelling of the finger.		Fig. 2 Lytic lesion evident on the radiograph.

Tubercular infection of metatarsals, metacarpals and phalanges is usually associated with active pulmonary involvement. Tubercular infection involving the phalanges results in characteristic spindle shaped swelling of fingers, a condition known as spina ventosa. Spina is a latin word for "short bone" and ventosa is a latin word for "inflated with air". The differential diagnosis of such a swelling includes syphilis and sickle cell dactylitis. Syphilis can involve the metaphysis or diaphysis. Syphilis, though rare now-a-days, can involve bone as a late manifestation of congenital syphilis or as acquired secondary syphilis in cases of sexual abuse in children. On X-ray, a zone of sclerosis or periosteal reaction is seen. Sickle cell dactylitis leads to an acute painful swelling of fingers or toes. Most patients with sickle cell disease suffer from hemolytic anemia. Vaso-occlusion causes recurrent episodes of painful crisis. The X-ray shows periosteal new bone formation followed by medullary resorption, coarsening of trabeculae and cortical thinning.