PMC4511758_01
RX AP (A) and oblique (B), showing ossification of soft tissues of the radial and flexor diaphyseal faces of the proximal phalanx of the third chirodactyl, with irregular and partially defined contours (arrows), cortical erosion (open arrows) and lamellar periosteal reaction (arrowheads) proximal and distal to the node, and increased volume and density of the adjacent soft tissue (open arrowheads).
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Plain radiography (RX) revealed ossification of soft tissues of the radial and flexor diaphyseal faces of the proximal phalanx of the finger, with irregular and partially defined contours, cortical erosion and lamellar periosteal reaction proximal and distal to the nodule, and increased volume and density of parts of the adjacent soft tissue (Fig. 1).
Axial slice CT scan reveals the ossification (arrows) advancing from the bone and that externally involved the cortical flexor (open arrows) contiguous to the radial and flexor aspect nodulation. The reconstruction in the coronal plane (D) depicts continuity of nodular lesion with periosteal reaction (arrowheads) extending to the flexor side.
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Computed tomography (CT) ratified these findings and demonstrated more clearly the ossification, extending from the bone and externally involving the cortical flexor contiguous with the radial and flexor aspect nodulation (Fig. 2).
MRI reveals expansive formation on soft parts of the radial face of the proximal phalanx with iso/hypersignal relative to muscle on T1 (A and C), mild hypersignal on T2 (B), and significant heterogeneous enhancement to paramagnetic contrast medium (D); slight thinning of the cortical bone (arrows), which superiorly displaces the extensor hood (arrowheads), associated with bone marrow edema pattern.
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The lesion depicted the iso/hypersignal relative to muscle on T1, heterogeneous signal with mild hypersignal on T2, and significant heterogeneous enhancement to paramagnetic contrast medium, associated with a bone marrow edema pattern (Fig. 3).
Five months after surgery, MRI scan in the coronal and axial plans (A, B) demonstrating absence of nodulation, and fibrocicatricial change (arrows) in the soft tissues, and after the administration of paramagnetic contrast (C), without areas of significant enhancement.
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Five months later, MRI depicted only fibrocicatricial changes in soft tissues, without significant enhancement in the contrast medium (Fig. 4).