Phalangeal microgeodic syndrome: findings on MR imaging

Phalangeal microgeodic syndrome: a paediatric case series

We present the clinical and radiological characteristics of phalangeal microgeodic syndrome in a cluster of five children during the second peak of COVID-19 pandemic in the UK. Each child presented with phalangeal swelling and erythema, prompting a comprehensive multi-disciplinary team review to analyse the clinical presentation, blood test results and imaging. The cohort's average age was 14.1 years, ranging from 10.4 to 16.6 years, with two girls and three boys. Four children experienced phalangeal involvement in the hands, whilst one was affected solely in the feet. A rheumatological work-up was performed for all. Hand X-rays performed on three children revealed distinct radiographic features like microgeodes, subperiosteal bone resorption and rarefaction in two cases. However, further MRI showed extensive changes closely correlated with the clinical signs of cutaneous vasculopathic rashes. The MRI abnormalities were notable, encompassing marrow oedema primarily affecting metaphyses and epiphyses, displaying broad transition zones. Soft tissue swelling and cortical erosions were also observed. These MRI features proved more pathognomonic in the acute clinical context. The study concluded that phalangeal microgeodic syndrome, characterised by digital swelling and erythema, might not be adequately assessed by plain X-rays. The more comprehensive MRI features, including marrow oedema and soft tissue abnormalities, appeared to be more indicative in diagnosing the condition. Considering the rarity of this syndrome and its temporal association with the COVID-19 pandemic, the study hypothesised that COVID-related thrombophilia and immune-mediated vasculopathy might act as crucial triggers for the active bony manifestations seen in this syndrome. KEY POINTS: • PMS is a rare, predominantly paediatric condition, of unknown aetiology which affects the digits. • Laboratory investigations are generally negative; however, in the appropriate clinical context, the X-ray findings of microgeodes and pattern of bone marrow oedema seen on MRI are pathognomonic. • Considering the rarity of PMS and temporal association with the COVID-19 pandemic, COVID vasculopathy may represent a previously unrecognised aetiology for PMS.

Phalangeal microgeodic syndrome, COVID-19, and antinuclear antibodies in a child: A case report

Phalangeal microgeodic syndrome (PMS) is a rare rheumatological disease affecting children strongly associated with cold weather. It is considered to be benign and self-limiting, with most cases resolving in warmer months, and no studies have investigated its association to autoantibodies or viral infection. In this peculiar case, a 12-year-old child with the previous COVID-19 infection developed PMS that did not improve in the warm weather and, subsequently, Raynaud's phenomenon and facial rash. With the increasing number of new studies showing the correlation between COVID-19 and autoimmunity, this case report highlights a plausible link between COVID-19, PMS, and autoimmunity in the pediatric population that should be investigated further.

Microgeodic disease in an infant

We describe an infant presenting with intermittent discolouration and swelling of her fingers and toes occurring with changes in ambient temperature. Extensive investigations revealed raised inflammatory markers as well as sclerotic lesions within the phalanges and diffuse marrow oedema. Infectious and inflammatory causes were considered and excluded based on the clinical presentation and investigation findings. The persistence of symptoms prompted further investigation with MRI. Correlation of the MRI findings with previous case reports resulted in a diagnosis of microgeodic disease-an uncommon, self-limiting condition thought to be due to cold-induced vasospasm leading to avascular necrosis of the bone.

Rare case of adult-onset phalangeal microgeodic syndrome of the feet

Phalangeal microgeodic syndrome (PMS) is a rare condition typically affecting children and is characterised by painful digits precipitated by cold temperatures. In medical literature, cases appear to be clustered in Japan. Adult-onset PMS is particularly rare and although imaging features are characteristic, it may go undiagnosed, as it is not commonly encountered. We present, to our knowledge, the fifth reported case in the literature of adult PMS, the second to affect the feet rather than hands, and the first in a Caucasian adult patient. This case report aims to raise awareness of this likely underdiagnosed condition to allow optimal management and avoidance of unnecessary diagnostic procedures.

Musculoskeletal involvement of COVID-19: review of imaging

The global pandemic of coronavirus disease 2019 (COVID-19) has revealed a surprising number of extra-pulmonary manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. While myalgia is a common clinical feature of COVID-19, other musculoskeletal manifestations of COVID-19 were infrequently described early during the pandemic. There have been emerging reports, however, of an array of neuromuscular and rheumatologic complications related to COVID-19 infection and disease course including myositis, neuropathy, arthropathy, and soft tissue abnormalities. Multimodality imaging supports diagnosis and evaluation of musculoskeletal disorders in COVID-19 patients. This article aims to provide a first comprehensive summary of musculoskeletal manifestations of COVID-19 with review of imaging.

Phalangeal microgeodic syndrome in childhood

BACKGROUND

Phalangeal microgeodic syndrome is an uncommon benign self-limiting condition that often occurs during cold weather. The etiology and the pathogenesis of the disease remain unclear.

OBJECTIVE

To report a series of children with phalangeal microgeodic syndrome.

MATERIALS AND METHODS

Twenty children with phalangeal microgeodic syndrome were retrospectively identified at our hospital after 2007. The clinical data, radiologic manifestation and pathologic appearance were analyzed.

RESULTS

The average age was 10.3 years (range: 6.5-14.6 years). Twelve patients were boys. Twenty-five phalanges were affected radiographically (23 middle phalanges [92%] and 2 proximal phalanges [8%]). On radiographs, there were multiple small phalangeal lacunae in all cases. Metaphyseal rarefaction was seen in 15 phalanges, and metaphyseal transverse lucent bands were found in 7 phalanges. Epiphyseal rarefaction was seen in three phalanges. On magnetic resonance imaging (MRI), diffuse signal abnormalities of affected phalanges were observed in all cases. Multiple other phalanges and metacarpals also showed marrow edema in three cases.

CONCLUSION

Phalangeal microgeodes may represent bone absorption and destruction in response to exaggerated peripheral circulatory impairment following chilblain, and mainly occur in bone growth spurts.

Phalangeal Microgeodic Syndrome in a Patient with Systemic Lupus Erythematosus

We herein report a woman in her 50s with systemic lupus erythematosus (SLE) who developed swelling and pain in her fingers; the symptoms were more prominent in winter. Magnetic resonance imaging (MRI) revealed bone edema in the phalanges of both hands, which was compatible with phalangeal microgeodic syndrome (PMS). This is the first reported case of PMS in a patient with SLE and suggests that performing MRI should be considered for patients with SLE in order to assess the nature of finger symptoms and signs more precisely.

Diffuse phalangeal signal abnormality on magnetic resonance imaging: phalangeal microgeodic disease

BACKGROUND

Phalangeal microgeodic disease is a rare and benign self-limited condition involving the phalanges, often in the setting of cold exposure, with characteristic MR imaging abnormalities. Radiographic case descriptions are predominantly from Asia and Europe, with only seven cases using MR to characterize phalangeal microgeodic disease.

OBJECTIVE

In this study we describe the MR imaging appearance of unusual and striking phalangeal signal abnormality compatible with phalangeal microgeodic disease at our institution in North America.

MATERIALS AND METHODS

We retrospectively reviewed cases presenting at our institution with unusual or unexplained phalangeal signal abnormalities between 2001 and 2014. We reviewed the MR imaging appearances in conjunction with radiographs and any other available imaging investigations.

RESULTS

Of 189 examinations reviewed during the study period, 8 imaging studies in 6 patients met the study inclusion criteria. Signal abnormality was present in 57 of 112 phalanges (51%), frequently involving the distal phalanges (70%, 28 of 40), followed by the middle phalanges (56%, 18 of 32) and the proximal phalanges (28%, 11 of 40). The pattern of involvement was most commonly diaphysis (38%), followed by metaphysis (32%) and epiphysis (30%). The extent of MR signal abnormality was greater than that suspected based on clinical presentation or on radiographs.

CONCLUSION

The presence of unexplained diffuse characteristic marrow involvement of multiple painful phalanges on MR images, often in the setting of cold exposure, should raise the possibility of phalangeal microgeodic disease. Consideration of this diagnosis based on MR findings would lead to a more conservative management and avoid unnecessary invasive diagnostic procedures.

The phalangeal microgeodic syndrome in childhood: awareness leads to diagnosis

Phalangeal microgeodic syndrome is a rare but benign disorder that affects the fingers of children. This condition was originally described by Maroteaux in 1970. We present two patients who consulted a pediatrician with swelling of the digits of one or both hands. Both lacked additional clinical or biochemical signs. Radiological examination showed multiple small osteolytic areas with sclerotic lining and periostal reactions in the phalanges of the affected hands. These cases were treated with a conservative approach and spontaneous resolution occurred within weeks to months. As it is a rare disease, the clinical presentation can be misinterpreted as an infectious, inflammatory, or even malignant condition and prompts clinicians to expand the diagnostic process with radiological or nuclear imaging and even biopsy. In these patients, a timely clinical diagnosis by a physician who is aware of the disease prevented further investigations.

Phalangeal microgeodic disease: report of two cases and review of imaging

Phalangeal microgeodic disease is a rare disease that is frequently (though not invariably) related to cold exposure. In most cases, the clinical and radiographic findings of phalangeal microgeodic disease are sufficient to reach the diagnosis. The magnetic resonance imaging (MRI) findings of phalangeal microgeodic disease have been described in four cases in the English literature with two additional cases presented here. MRI allows a greater appreciation of affected bone areas and adds specificity to radiography with regard to diagnosis. In this sense, MRI is a helpful investigation in those cases of phalangeal microgeodic disease when doubt still exists following clinical and radiographic assessment.

Magnetic resonance imaging findings of microgeodic disease of the toe: a case report

Level of Evidence: V, Expert Opinion

Phalangeal microgeodic syndrome resulting in rapid digital shortening

Microgeodic phalangeal syndrome is a rare condition affecting the fingers in children. Radiographically, the affected phalanges show sclerosis with multiple small areas of osteolysis. The pathogenesis of microgeodic phalangeal syndrome is considered to be a transient disturbance of the peripheral circulation caused by cold temperatures. In most cases, the symptoms and the radiographic changes return to normal within several months without any treatment. We present a rare case of microgeodic phalangeal syndrome in the middle phalanx of the right index finger in an 8-year-old girl, in whom the affected phalanx shortened within 6 weeks of the initial presentation. It was speculated that minor trauma to the finger might have contributed to the collapse and shortening of the phalanx. The current case indicates that the use of a splint for the affected finger in the early period after onset of symptoms might be recommended to avoid digital shortening.