Figure 5.

48 year-old man with voriconazole-induced periostitis following stem cell transplant for acute lymphoblastic leukemia. Single anteroposterior (A) radiograph of the right hand and coned down images at right demonstrate irregular, bulky periosteal new bone formation involving the first proximal phalanx medially (B), the fifth metacarpal medially (C) (arrows), the distal radial metadiaphysis laterally (D), and the distal ulnar diaphysis laterally (E). Coned down image of the fifth metacarpal (C) also demonstrates sclerosis and abnormal morphology of the fifth metacarpal head consistent with prior fracture (dashed arrow).