case_images: PMC5080871_01
case_images: Radiographs at the time of the initial consultation at our hospital show small radiolucent spots in the middle phalanx of the left index finger on anteroposterior (A) and lateral (B) views. The left index finger appears distinctly reddish (C, D). Irregular shadows are observed on the distal phalanx of the left hallux and middle phalanx of the left second toe (E, F).
case_images: TOORTHJ-10-500_F1.jpg
case_images: PMC5080871_01_TOORTHJ-10-500_F1.jpg
case_images: F1
case_images: Radiography at the initial consultation showed small, round, radiolucent images in the middle phalanx of the left index finger, as well as an irregular shadow on the distal phalanx of the left hallux and middle phalanx of the left second toe (Fig. 1). Conditions at that time included mild pain, spindle-shaped swelling, and redness over the left index finger and left hallux and second toe (Fig. 1).
case_images: T1- and T1-weighted fat-suppression magnetic resonance imaging (MRI) shows lesions with low signal intensity in the middle and proximal phalanges of the index finger (A, C, E). T2-weighted MRI showed high signal intensity in the intramedullary regions that showed low signal intensity on T1-weighted imaging (B, D).
case_images: TOORTHJ-10-500_F2.jpg
case_images: PMC5080871_01_TOORTHJ-10-500_F2.jpg
case_images: F2
case_images: Magnetic resonance imaging (MRI) showed low-intensity areas on T1-weighted and T1-weighted fat suppression imaging (Fig. 2).
case_images: Two months after symptom onset, an irregular shadow is seen on the middle phalanx of the left index finger, indicating pathological fracture (A, B).
case_images: TOORTHJ-10-500_F3.jpg
case_images: PMC5080871_01_TOORTHJ-10-500_F3.jpg
case_images: F3
case_images: Two months after the onset of symptoms, radiography showed an irregular shadow and fracture-like condition in the middle phalanx of the left index finger (Fig. 3).
case_images: Three months after symptom onset, less cortical irregularity is evident in the middle phalanx of the left index finger (A, B). Four months after symptom onset, no irregular shadows are apparent in the middle phalanx of the left index finger (C, D).
case_images: TOORTHJ-10-500_F4.jpg
case_images: PMC5080871_01_TOORTHJ-10-500_F4.jpg
case_images: F4
case_images: Swelling and redness in the left hallux and second toe were also improved, but irregular shadows again remained visible on radiographs (Fig. 4A, B). Irregular shadows on the left index finger and left hallux and second toe were also no longer apparent on radiographs (Fig. 4C, D).