This patient has periosteal reaction along the medial margins of the distal radius and ulna.
The differential diagnosis for a solitary site of periosteal reaction includes the following entities:
However, this patient has periosteal reaction in two different bones. This should make one consider causes of generalized periosteal reaction, which is a somewhat shorter list:
This patient is an adult, and the adjacent wrist joints look fine, making the first two entities on this list unlikely. Multifocal osteomyelitis is possible, but there are no other bony abnormalities, making that less likely. Venous stasis tends to cause periosteal reaction mostly in the lower extremities, leaving hypertrophic pulmonary osteoarthropathy as a likely cause. Therefore, our attention should be turning to the chest as a possible source for this patient's findings.
So, here is an AP radiograph of the chest. What do you think?
