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63 year old Female, Hand pain
Findings?

Same patient - Foot
Findings, DDx?

Same patient after 2 yrs. Rx
Try to give Dx/ DDx before Continuing…

Additional Images Found In Patient’s Javcket- “Classic”
Summary of Findings and Final Dx?

Sarcoid of Bone

• Initial images showed a reticulated, “lacelike” pattern involving the 2nd and 5th digits of the left hand, and the 3rd and 5th digits of the right hand. Foot image showed well-defined cystic/ lacelike lesions in the distal phalanx of the 1st digit.
• Mineralization and joint spaces essentially normal; no erosions
•  Lesions improved after systemic treatment (MTX & Steroids)
• CXR & MRI confirmed sarcoid findings in the chest & brain
• Can also have neuropathy-like destruion of distal phalanges (not present in this case)
• Osseus involvement seen in 6-20% of sarcoid cases