Age / Sex : 45 / F

Chief complaint
: Raynaud phenomenon

What is your impression? 

Two weeks later, you can see the final diagnosis with a brief discussion of this case. (Please submit only one answer)

Courtesy : Hye Jin Yoo, Seoul National University Hopital

Acro-osteolysis in systemic sclerosis

Discussion

Findings:

Bony resorption of the distal phalanx on
radiogrphy. CT demonstrate reticular opacities in the subpleural regions
suggestive of interstitial lung disease.

Differential Diagnosis:

 Psoriatic
arthritis, Thermal injury, Hyperparathyroidism, Dermatomyositis, Leprosy

Diagnosis: 

Acro-osteolysis in systemic sclerosis

Discussion:

Acro-osteolysis refers to resorption of the distal
phalanx. The terminal tuft is most commonly affected but the shaft of the distal
phalanx can also be affected in a few conditions. It is associated with a
heterogeneous group of pathological entities including systemic sclerosis. Systemic sclerosis is a rare multisystemic
disease that preferentially affects middle-aged women. Hand involvement is a
major feature in patients with systemic sclerosis. Acro-osteolysis is a characteristic feature of systemic sclerosis and has been estimated to occur in around 20-25% of patients.
It is often assumed that acro-osteolysis results from impairment of blood
supply, although pressure from skin tightening may also play a role.

References:

http://radiopaedia.org/articles/acro-osteolysis-1

Acro-osteolysis in systemic sclerosis is associated
with digital ischaemia and severe calcinosis Rheumatology 2012;51: 2234-2238

Hand and Wrist Involvement in Systemic Sclerosis:
US Features Radiology 2013; Vol 269 (3): 824-830

Acro-osteolysis Etiologic and Radiological
Considerations JAMA 1986; Vol 255 (15): 2058-2061