Tehran University Medical Journal

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Bone age determination is one of the important radiological methods of diagnosis. However, unfortunately considerable misunderstanding is seen among physicians and even radiologists. This is due to a general lack of knowledge concerning basic concepts, normal variation and the areas choosing for X-Ray. Most of errors are attributable to ignorance of the expected range of normal bone development. A well-known atlas of wrist and hand by "Greulich and Pyle" is widely accepted because of its simplicity and low radiation exposure, but the bones of these areas do not necessarily reflect development of the skeleton generally. This method is more abused by referring physicians when they limit the X-Ray to the wrist region, which considerably reduces accurate assessment. In this paper, different aspects of subject, including assessment and clinical use of neonatal bone maturation, such as hypothyroidism, low birth weight babies, and respiratory distress syndrome are also dicussed.

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Background: Tumoral calcinosis is a hereditary disorder of metabolic dysfunction of phosphate regulation. It is an idiopathic calcinosis that characterized by the deposition of calcium phosphate in periarticular tissues that causes typically lobulated, well demarcated calcification around large joints particularly the extensor surfaces. It is usually painless. It is common in puberty age and adolescents. The involvement of the hand phalanges is very rare that can make a mistake in diagnosis if it is infected. Tumoral calcinosis is seen the same in both sexes. The electrolyte levels of calcium and phosphorus is normal and sometimes is hyperphosphatemia. It is the first report of tumoral calcinosis in Iran. Case report: A 7-year-old girl presented with redness, yellowish discharge and painful swelling of the left hip and the third web space of left hand admitted to Vali-e-Asr Hospital, Tehran, Iran, in 2013. The onset of the disease was 3.5 years ago. She did not mention the family history of the disease. The pain was at the left hip first. Six months later the third and fourth phalanges of the left hand was swollen. Physical examination revealed an erythematous mass in the extensor surfaces of the third and fourth metacarpals of the left hand. It was tender in palpation. The smear and culture of discharge was staphylococcus aureus. X-rays revealed calcification of the third and fourth metacarpals of the left hand. The entire lesion was managed by surgical excision. Successful postoperative medical management in the form of low calcium and low phosphorus diet and oral cloxacillin was performed. Conclusion: Tumoral calcinosis involves rarely the interphalangeal joints of hand. Because of its compression over adjacent nerves, it is painful. Sometimes it has a sterile discharge and rarely superimposed infections may occur. Radiologists can play a major role in early diagnosis and probable complications.