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Case Nineteen - Sarcoidosis of Hands

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Clinical History: A 42 year old white male with long history of sarcoidosis. The diagnosis established by clinical symptoms, chest x-ray examination and biopsy of lungs and mediastinal lymph nodes.

Findings: Diffuse trabecular change, leading to a lattice work or lacy network configuration and multiple lucent lesions of varying sizes are found in the fingers. The lytic change produces the cystic-like appearance. The cystic changes can appear centrally or eccentrally. Acro-osteosclerosis is not found in this case.

Diagnosis: Sarcoidosis of hands.

Discussion: Sarcoidosis is a granulomatous disease affecting multiple organ systems. It is more common in young adults. The bone changes often are asymptomatic. The hands are the predominant site. They are mostly bilateral and symmetrical. 90% of patients that have bone changes will have x-ray evidence of pulmonary sarcoidosis.

References:
Holt JF, Owens WJ. The Osseous Lesion of Sarcoidosis. Rad. 53:11,49.

Fitzgerald P, Meenan FOC. Sarcoidosis of the Hands. J Bone Joint Surg. 40B:256,258.

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Submitted by:
Kenneth Fung, M.D.