PDF(Pubmed)
Abstract：
BACKGROUND: Evaluating isolated extremity discomfort can be challenging when initial imaging and exams provide limited information. Though subtle patient history hints often underlie occult pathologies, benign symptoms are frequently miscategorized as idiopathic.
METHODS: We present a case of retained glass obscuring as acute calcific periarthritis on imaging. A 48-year-old White male with vague fifth metacarpophalangeal joint pain had unrevealing exams, but radiographs showed periarticular calcification concerning inflammation. Surgical exploration unexpectedly revealed an encapsulated glass fragment eroding bone. Further history uncovered a forgotten glass laceration decade prior. The foreign body was removed, resolving symptoms.
CONCLUSIONS: This case reveals two imperative diagnostic principles for nonspecific extremity pain: (1) advanced imaging lacks specificity to differentiate inflammatory arthropathies from alternate intra-articular processes such as foreign bodies, and (2) obscure patient history questions unearth causal subtleties that direct accurate diagnosis. Though initial scans suggested acute calcific periarthritis, exhaustive revisiting of the patient\'s subtle decade-old glass cut proved pivotal in illuminating the underlying driver of symptoms.
CONCLUSIONS: Our findings underscore the critical limitations of imaging and the vital role that meticulous history-taking plays in clarifying ambiguous chronic limb presentations. They spotlight the imperative of probing even distant trauma when symptoms seem disconnected from causative events. This case reinforces the comprehensive evaluation of all subtle patient clues as key in illuminating elusive extremity pain etiologies.
METHODS: We present a case of retained glass obscuring as acute calcific periarthritis on imaging. A 48-year-old White male with vague fifth metacarpophalangeal joint pain had unrevealing exams, but radiographs showed periarticular calcification concerning inflammation. Surgical exploration unexpectedly revealed an encapsulated glass fragment eroding bone. Further history uncovered a forgotten glass laceration decade prior. The foreign body was removed, resolving symptoms.
CONCLUSIONS: This case reveals two imperative diagnostic principles for nonspecific extremity pain: (1) advanced imaging lacks specificity to differentiate inflammatory arthropathies from alternate intra-articular processes such as foreign bodies, and (2) obscure patient history questions unearth causal subtleties that direct accurate diagnosis. Though initial scans suggested acute calcific periarthritis, exhaustive revisiting of the patient\'s subtle decade-old glass cut proved pivotal in illuminating the underlying driver of symptoms.
CONCLUSIONS: Our findings underscore the critical limitations of imaging and the vital role that meticulous history-taking plays in clarifying ambiguous chronic limb presentations. They spotlight the imperative of probing even distant trauma when symptoms seem disconnected from causative events. This case reinforces the comprehensive evaluation of all subtle patient clues as key in illuminating elusive extremity pain etiologies.
摘要：
背景：当初始成像和检查提供的信息有限时，评估孤立的四肢不适可能是具有挑战性的。尽管微妙的患者病史提示通常是隐匿性病理的基础，良性症状经常被错误地归类为特发性。
方法：我们在影像学上介绍了一例残留玻璃模糊为急性钙化性周关节炎的病例。一名48岁的白人男性，患有模糊的第五掌指关节疼痛，但检查未发现，但是X光片显示关节周围钙化与炎症有关。手术探查意外地发现一个包裹的玻璃碎片侵蚀了骨头。进一步的历史发现了十年前被遗忘的玻璃撕裂。异物被移除，解决症状。
结论：该病例揭示了非特异性四肢疼痛的两个必要诊断原则：（1）高级影像学缺乏特异性，无法区分炎性关节病与其他关节内过程，例如异物，（2）模糊的患者病史问题揭示了指导准确诊断的因果关系。虽然最初的扫描显示急性钙化性关节炎,详尽的重新审视患者的微妙的十年历史的玻璃切割被证明是关键的，在阐明潜在的驱动因素的症状。
结论：我们的研究结果强调了成像的严重局限性，以及细致的病史记录在澄清模糊的慢性肢体表现方面的重要作用。当症状似乎与致病事件脱节时，他们强调了探索甚至远处创伤的必要性。此病例加强了对所有细微患者线索的综合评估，这是阐明难以捉摸的四肢疼痛病因的关键。
方法：我们在影像学上介绍了一例残留玻璃模糊为急性钙化性周关节炎的病例。一名48岁的白人男性，患有模糊的第五掌指关节疼痛，但检查未发现，但是X光片显示关节周围钙化与炎症有关。手术探查意外地发现一个包裹的玻璃碎片侵蚀了骨头。进一步的历史发现了十年前被遗忘的玻璃撕裂。异物被移除，解决症状。
结论：该病例揭示了非特异性四肢疼痛的两个必要诊断原则：（1）高级影像学缺乏特异性，无法区分炎性关节病与其他关节内过程，例如异物，（2）模糊的患者病史问题揭示了指导准确诊断的因果关系。虽然最初的扫描显示急性钙化性关节炎,详尽的重新审视患者的微妙的十年历史的玻璃切割被证明是关键的，在阐明潜在的驱动因素的症状。
结论：我们的研究结果强调了成像的严重局限性，以及细致的病史记录在澄清模糊的慢性肢体表现方面的重要作用。当症状似乎与致病事件脱节时，他们强调了探索甚至远处创伤的必要性。此病例加强了对所有细微患者线索的综合评估，这是阐明难以捉摸的四肢疼痛病因的关键。
