Scleroderma

This is a patient who presented with pain and swelling of the fingertips. Frontal and lateral radiographs of the hand were obtained. The frontal radiograph demonstrates erosion and destruction of the distal phalanges of multiple fingers with overlying soft tissue swelling as indicated by the red arrows. The red arrow on the lateral radiograph points to calcification with a popcorn appearance in the soft tissues of the distal phalanx of the thumb. These erosion of mutiple distal phalanges is referred to as acrosteolysis. Acrosteolysis with soft tisse calcification is virtually pathognomonic for scleroderma, which is the diagnosis in this cases. Addtional causes of acroosteolysis would include thermal injury, trauma, or osteolysis in the setting of renal failure.