Hi folks,
Thanks for the responses. To answer some questions that were raised – the patient is not diabetic, no rash or nailfold changes, no toes/feet involvement (based on history/exam, no imaging of the feet was performed). Our protocol involves scanning both the dorsal and volar aspects of the wrist, MCP and IP joints. The hyperemia was mainly seen at the volar aspect of the fingers in this patient – there was relatively minimal hyperemia dorsally. Per rheumatology request, we ask the patients prior to the ultrasound if they are on any anti-inflammatory medication and include that information in the report – this patient was not on any anti-inflammatory meds.
I asked one of my colleagues and she thought the hyperemia may be related to the temperature in the room or the cold weather (it has been quite cold lately). To be honest, I have scanned myself and seen hyperemia in my fingers occasionally – hopefully I don’t have some condition!
Here is what I have so far from OCAD:
I’ve seen a few cases like this on volar fingers without joint / tendon involvement. Most recently saw one in the last few weeks. An older gentleman with steroid responsive pain / swelling but not erosions on xr and no clinical / lab dx.
I would have called this normal vascularity of the fingers on US but would be interested to know what the others think.
Consider RS3PE, sclerodactyly, scleroedema.
Is she diabetic?
Any rash or nailfold changes? Any toes/feet involvement?
For hand joints synovitis, we usually ultrasound the dorsal extensor aspects of the joints, not the volar.
I too have seen this often in isolation and not sure what to make of it. Sometimes I have seen it in patients with psoriatic or other seronegative arthritis in the setting of some mild tenosynovitis (like a forme fruste sausage digit) but most of the time it seems the subq hyperemia is an isolated incidental finding.
Very confusing to have no skin edema accompanying the subjacent hyperemia. I saw nothing in the literature to make this prognostic of any condition.
I welcome any more comments or thoughts.
Thanks again for your insight!
Emad
On Fri, Feb 16, 2024 at 9:46 PM Emad wrote:
Hi OCADers,
Wanted to pick your brains on an ultrasound finding that I see occasionally but not sure about its significance. I’ve attached 5 hand ultrasound images from a patient. These show subcutaneous hyperemia. Otherwise negative rheumatologic survey ultrasound of the bilateral wrists/hands. Joints and tendons looked ok.
The bilateral hand radiographs were also negative, other than some thumb CMC joint osteoarthritis and presumed chronic injury to the right thumb near the IP joint. This particular patient was a 60 year old female with bilateral hand pain and stiffness. Swelling and tenderness of the MCPs was mentioned on physical exam. RF and CCP negative, sed rate mildly elevated at 42, positive ANA 1: 160 nuclear speckled. "Speckled pattern is associated with mixed connective tissue disease (MCTD), systemic lupus erythematosus (SLE), Sjogren’s syndrome, dermatomyositis, and systemic sclerosis/polymyositis overlap."
Any thoughts on the ultrasound findings? Assuming it’s not technical/artifactual.
Thanks!
Emad
