Presentation
Pain in the web space between the 4th and 5th fingers.
Patient Data
Irregular calcification is seen at the radial aspect of the 5th metacarpophalangeal joint, possibly involving the radial/lateral collateral ligament with surrounding soft tissue edema extending to the web space between the 4th and 5th digits and possibly to the digital nerve in this region.
Thickening and hyperintensity/inflammation involving the sheath of flexor tendons of the 5th digit start just proximal to the level of the head of the 5th metacarpal and extend distally up to the distal interphalangeal joint. Significant surrounding edema and fat stranding are seen.
Mild hyperintensity/inflammation are also seen involving the extensor tendon sheath starting at the level of the metacarpophalangeal joint and extending up to the midshaft of the proximal phalanx.
No obvious marrow edema is seen involving the bones of the 5th digit in the present scan.
Note is made of a subcortical hyperintense lesion measuring approximately 5 mm in the head of the 3rd metacarpal, possibly an intraosseous ganglion.
The CT confirms the calcification at the radial aspect of the 5th metacarpophalangeal joint.
Case Discussion
The above findings are suggestive of acute calcific periarthritis, which is the likely cause of pain.
Hyperintensity and inflammation along the flexor and extensor tendon sheaths of the 5th digit are likely peritendinitis/tenosynovitis.
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