Uncategorized

HANDS and HEART

Jaccoud’s Osteoarthropathy
JACCOUD’S ARTHROPATHY
65 year old female with longstanding history of SLE, Lupus Sjogren’s and Raynaud’s  Xray shows non erosive arthropathy with ulnar deviation of 2nd through 5th MCP joints
Ashley Davidoff MD

SLE and the Heart TCV

  • Pancarditis
    •  pericardium, pericarditis 25% most common
    • myocardium, myocarditis is rare  caused by vasculitis
    • myocardial infarction 9X increase
    • endocardium ? Libman-Sacks 10%  mitral and tricuspid valve
  • Cardiac complications in  about 50% and major cause of death
Soft Tissue Calcification Ulnar Deviation
SCLERODERMA
Radiographs of both hands show abnormal alignment of the metacarpophalangeal joints, most marked on the left, in keeping with subluxation. The bone density appears normal. There is joint space loss and evidence of erosive arthropathy particularly evident at the metacarpophalangeal joinft of the right 3rd and 4th MCP’s. Dense soft tissue calcifications are seen in the fingertips and along the ulnar aspect of the right wrist/distal forearm.
Case courtesy of Dr Jan Frank Gerstenmaier,
Radiopaedia.org, rID: 23125
Acroosteolysis
SCLERODERMA
Acroosteolysis in a female patient with scleroderma
Case courtesy of Dr Minh Xuan Truong,
Radiopaedia

Scleroderma and the Heart
Pancarditis

  • pulmonary hypertension secondary to lung and renal disease
    • right sided disease ? increase RV and RA
  • pericardial disease
  • myocardial disease, ? myocardial fibrosis
  • conduction system abnormalities, arrhythmias,
  • Endocardium and valvular disease ? infrequent

  • Scleroderma,  Pulmonary Hypertension RVF Cor Pulmonale Pericardial effusion 
    40 year old female with known interstitial lung disease (a and b) shows enlarged right atrium and right ventricle and small pericardial effusion (c and overlaid in maroon in d) and enlarged esophagus (overlay in pink in d) and an edematous gallbladder wall from chronic right heart failure.

Rheumatoid Arthritis

Erosive Osteoarthritis dominant in the MCPs and Carpals

RHEUMATOID ARTHRITIS
Showing degenerative and erosive changes dominantly at the MCP joints, intercarpal joints, ulnar carpal and radiocarpal joints and to lesser extent the PIP joints. There is ulnar deviation more prominent on the right hand
Ashley Davidoff MD

Rheumatoid Arthritis and Heart Disease TCV
RA and the Hand TCV

  • Pancarditis and and increased incidence of
    • congestive heart failure and
    • ischemic heart disease associated with an
    • increased mortality

 

Gout and the Heart

GOUTY ARTHROPATHY WITH EROSIONS
Plain film examination of both hands (upper panel) show erosions and soft tissue swelling. On the left hand erosions there are deep erosions with overhanging edges and relative sparing of the joint surfaces characteristic of gout arthropathy. These changes are most prominent in the 3rd and 4th phalanges of the left hand (lower set of images (a-e) The middle and distal 3rd phalanx show the erosive changes around the DIP demonstrated in images b and c with red overlay. The erosions are also exemplified in the proximal phalanx of the 4th finger- where a large erosion associated with soft tissue swelling is noted (d,e, green overlay) There are erosions on the right digits as well, but these are less obvious.
Ashley Davidoff MD
  • Gout and the Heart
      • Increase Coronary Artery Risk

Holt Oram Syndrome

Buzz

 

Multiple skeletal abnormalities including absent radius and absence and deformities along the radial aspect of the carpal and metacarpal bones
Courtesy Radiopaedia

Holt Oram Syndrome

  • carpal bone anomalies (100%)
  • ASD 75% but many other associated cardiac anomalies

 

HOLT ORAM SYNDROME
Holt Oram Syndrome s characterised by radial abnormalities and in this case there is absence of the left thumb.
Courtesy Radiopaedia
ASD SECUNDUM – MRI
The axial image through the heart at atrial septal level shows a flow void through a secundum ASD. The pink blood of the LA is shown shunting across and mixing with the blue blood of the enlarged RA.
01649b03 heart cardiac atrial septum secundum ASD secundum atrial septal defect secundum defect of the septum primum turbulence enlarged right atrium RAE right atrial enlargement congenital MRI Courtesy Ashley Davidoff MD copyright 2008

ASD Secundum TCV

ARACHNODACTYLY and MARFAN”S SYNDROME
ARACHNODACTYLY and MARFAN”S SYNDROME
Courtesy Wiki Commons

Sinotubular Ectasia ? Marfan?s Syndrome
72712 thoracic aorta sinus of Valsalva aortic sinuses sinotubular junction of ascending aorta sinotubular ectasia fx dilated CTscan Courtesy Ashley DAvidoff MD 72709

Marfan’s Syndrome TCV

  • Mitral Valve prolapse
  • Aortic and Sinotubular Ectasia
    • Aortic regurgitation
  • Arrhythmias

 

 

 

RHEUMATOID ARTHRITIS
Showing degenerative and erosive changes dominantly at the MCP joints , intercarpal joints, ulnar carpal and radiocarpal joints and to lesser extent the PIP joints. There is ulnar deviation more prominent on the right hand
Ashley Davidoff MD

Rheumatoid Arthritis and Heart Disease TCV
RA and the Hand TCV

 

 

hands-0014-catalogue-signed.jpg

 

Orientation and Positions of the Right Atrium, (RA), Right Ventricle (RV) Right ventricular Outflow Tract (RVOT)
If one places one’s right hand in the air then the thumb points to the RA, and the fingers to the RVOT, pointing in direction toward the left shoulder.
keywords
cardiac heart SVC right atrium right ventricle right ventricular inflow RV sinus RVOT infundibulum conal septum D loop aorta subpulmonary conus conal septum embryology anatomy
Ashley Davidoff MD
47777c04b
Bacterial Endocarditis and the Hand
SPLINTER HEMORRHAGE UNDER FINGERNAIL AND BACTERIAL ENDOCARDITIS.
Author Splarka
Wiki Commons
JANEWAY LESION on palm of a 36 year old male with staphylococcus endocarditis
Author Warfieldian
OSLER’S NODES
Osler’s nodes on left hand from a 43 year old male with subacute bacterial endocarditis.
Author Roberto J. Galindo

Heavy Vegetation on the Mitral Valve
13414 heart + cardiac mitral valve + bacterial endocarditis papillary muscles chordae fx vegetation dx SBE gross pathology Courtesy Henri Cuenoud MD TCV

Acute Multicentric Non Hemorrhagic Infarcts Consistent with Embolic Disease
Multicentric Infarcts in the Cerebellum and Occipital Lobes Multicentric low density regions in both posterior cerebellar hemispheres and the occipital lobes bilaterally seen in (a and b) correspondingly overlaid in light red in c and d, are consistent with non hemorrhagic infarcts. Embolic disease is most likely  Courtesy Ashley Davidoff MD 74923c01

Single Palmar Crease Downs Syndrome and Congenital heart Disease
    • 50 percent of infants  have some form of heart condition,
      • most common
        • Atrioventricular septal defect, (30 -45 %)
        • Patent ductus arteriosus, and (5-10%)
        • Tetralogy of Fallot. (2-5%)
DOWN’S SYNDROME, SINGLE PALMAR CREASE AND CONGENITAL HEART DISEASE
An adult hand showing a single transverse palmar crease
Source WurdBendur
COMPLETE ATRIOVENTRICULAR SEPTAL DEFECT.
Four-chamber CT image shows an atrioventricular septal defect consisted of a primum atrial septal defect (A) and an inlet ventricular septal defect (V) (a). The right atrium (RA) and the right ventricle (RV) are enlarged. The right ventricular hypertrophy is also noted. En face view reveals the size and shape of the defect (long arrows) (b). The atrioventricular valve (short arrows) is noted
Courtesy radiologykey.com

References and Links