Hydroxyapatite deposition disease: a common disease in an uncommon location

Excerpt

A 51-year-old right-handed female presented to the emergency department with a 3-day history of progressive right hand thenar eminence pain, swelling and warmth. The patient denied history of fever, trauma or relevant family history. Past medical history is only remarkable for a history of cellulitis of the right wrist 6 years ago. Her current symptoms presented acutely and were concordant with the physical examination findings of swelling, erythema, warmth and painful range of passive and active motion in all directions. There were no skin lacerations; however, palpation of the wrist was exquisitely tender. Given the clinical and physical examination findings, the working diagnosis of cellulitis was entertained with blood work and a right wrist radiograph was performed. The blood work demonstrated a normal white count, C-reactive protein and estimated sedimentation rate. Plain radiographs of the right wrist (Fig. 1) demonstrated an amorphous calcification projecting within the soft tissues inferior and adjacent to the trapezium, which was not present on radiographs 6 years prior, with mild overlaying soft tissue swelling and no fracture or erosion. Given the clinical and radiological findings, the diagnosis of hydroxyapatite deposition disease of the hand was made.

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