Radiographic Synopsis

AP and lateral projections

1. Bandlike areas of lucency across the waist of the terminal phalanges; tuftal resorption; finger shortening and clubbing in late stages (acro-osteolysis of Shinz; occupational vinyl chloride exposure)

2. Resorption of tufts and bandlike areas of lucency across the waist of the terminal phalanges, isolating small osseous fragments; soft tissue swelling; craniodysplasia; multiple wormian bones; micrognathia; osteoporosis; multiple fractures (Hajdu-Cheney syndrome)

3. Progressive tuftal resorption, starting with loss of the cortical line (lacelike appearance) and progressing towards tuftal destruction and osteolysis of the phalangeal waist; in occasional cases, bandlike radiolucent areas separating the tuft from phalangeal base reminiscent of the familial forms of acro-osteolysis (hyperparathyroidism; renal osteodystrophy)

4. Resorption and/or bandlike areas of lucency in the terminal phalanges, with progression of the lytic process in some areas, and regression in others; diffuse osteosclerosis (pyknodysostosis)

5. Tuftal resorption comparable in extent to loss of overlying soft tissue structures; swelling and tissue necrosis (acute phase); epiphyseal injury (in children) with fragmentation, destruction, and premature fusion; secondary osteomyelitis and arthritis (frostbite)

6. Tuftal resorption of extent comparable to loss of overlying soft tissue structures; osteoporosis; periostitis; osteophytosis; periarticular calcification and ossification; joint destruction, followed by ankylosis (thermal and electrical burns)

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