Clinics in diagnostic imaging (209)

Abstract

A 53-year-old woman presented to the emergency department with pain and swelling in the left ring finger for three months that had worsened after she accidentally hit her finger against the edge of a table. She had no constitutional symptoms and no significant medical history except for diabetes mellitus. Clinical examination revealed localised swelling and tenderness over the proximal phalanx of the left ring finger. Initial laboratory results showed a total white blood cell count of 8.3 (normal range [NR] 4.0-10.0) × 103/mL, C-reactive protein level of 0.4 (NR < 3.0 mg/L), serum phosphate level of 1.27 (NR 0.65-1.65 mmol/L) and serum calcium level of 2.34 (NR 2.1-2.6 mmol/L). Plain radiography of the left ring finger was performed at the initial presentation at the emergency department (Fig. 1a) and the one-month follow-up (Fig. 1b). What do the radiographs show? Based on the radiographic findings, magnetic resonance (MR) imaging of the left ring finger (Fig. 2) was subsequently performed. When interpreted with the radiography findings, what is the likely diagnosis? CMEArticle