Medical Imaging Analysis Report

I. Imaging Findings

1. Hand X-ray: Small patchy, reticular, or punched-out lytic lesions are observed in the distal phalanx of the fourth finger on the left hand and adjacent phalanges. There are irregular changes of the local cortex and trabecular structures, with mild expansion of the phalangeal shape, possibly accompanied by soft tissue swelling. The joint spaces remain largely normal, and there is no obvious sign of articular surface involvement.
2. MRI (T1, T2 weighted images, and contrast-enhanced scans): The lesion area in the distal phalanx shows slightly prolonged T2 signal, with abnormal bone marrow signal extending slightly into the soft tissue. Contrast enhancement reveals a certain degree of enhancement, and edema signals can be seen in the surrounding soft tissues.
3. Chest X-ray: Bilateral hilar shadows appear widened, possibly suggesting mediastinal lymph node enlargement. Increased lung markings may indicate pulmonary (or lymph node) involvement.

II. Potential Diagnoses

1. Sarcoidosis: Non-caseating granulomas are its pathological hallmark, potentially involving multiple systems, especially hilar lymph nodes, bone lesions, and skin changes. Small bone lesions often affect the fingers (or toes), presenting as reticular or punched-out lytic lesions and changes in the trabecular structures.
2. Tuberculosis or other granulomatous diseases: Bone tuberculosis often shows caseous necrosis, typically with more pronounced local destruction, often accompanied by evident soft tissue abscess or sinus formation. The X-ray findings differ from the relatively milder changes observed in this case.
3. Disseminated bone disease (e.g., metastatic lesions or local lymphoma-like disease): Usually accompanied by significant systemic symptoms or a history of primary malignancy, with bone destruction often presenting as lytic or mixed-type lesions. Metastases to the phalanges are relatively rare.
4. Hemangioma or Xanthomatosis: Hemangiomas generally appear on imaging as expansile bone lesions with internal septations, usually with well-defined margins; clinical symptoms may differ. Xanthomatosis can also present with some lytic changes but typically is associated with hyperlipidemia or related history.

III. Final Diagnosis

Considering the patient’s age (38-year-old male), localized painful swelling of the left finger, the net-like or punched-out lytic bone lesions on X-ray and MRI, as well as the chest X-ray findings suggesting possible bilateral hilar lymph node enlargement, the most likely diagnosis is Sarcoidosis.
Further confirmation may include:
- Serum ACE (angiotensin-converting enzyme) tests;
- Kveim test;
- Bronchoscopy or biopsy of the lesion to confirm the pathological feature of non-caseating granulomas.

IV. Treatment Plan and Rehabilitation

1. Treatment Plan

- Medications: For patients with significant symptoms and involvement of important organs, consider glucocorticoids (e.g., prednisone). Immunosuppressants (e.g., methotrexate) may be added as needed to control the inflammatory response.
- Follow-up Observation: In cases where lesion extent is limited and symptoms are mild, periodic follow-up of imaging and clinical symptoms may suffice, as some cases can resolve spontaneously.
- Other Treatments: For severe bone destruction or significant functional impairment, specialized evaluation may be required to determine if surgical intervention is necessary, especially in cases of finger joint deformity or serious functional limitation.

2. Rehabilitation and Exercise Prescription

As lesions involve the phalanges and potentially other sites, rehabilitation should include hand function training and consideration of overall health. Recommended plan is as follows:
(1) Early Stage:
- Focus on joint range-of-motion exercises and light muscle strength training; avoid excessive loading or large stretching movements.
- Perform 2-3 sessions of active flexion-extension exercises for the finger joints each day, each session lasting 10-15 minutes, with moderate intensity and a gradual approach.
- Keep the hand warm and protected to reduce pain and inflammation.
(2) Mid Stage:
- As pain subsides and swelling decreases, gradually add finger grip training (e.g., using a grip ring or soft rubber ball). Perform 8-10 sets each time, 10-15 repetitions per set.
- Incorporate upper-limb coordination exercises, such as kneading dough or finger-thumb opposition practice, to enhance fine motor skills.
(3) Late Stage:
- When joint range of motion is nearly normal, gradually introduce resistance training and functional exercises, such as light dumbbells or resistance bands, to improve wrist, forearm, and hand strength.
- Progressively return to daily and work-related fine motor activities, ensuring a gradual increase and avoiding excessive fatigue.
(4) Whole-Body Exercise and Cardiopulmonary Maintenance:
- In cases of pulmonary involvement, pay attention to cardiopulmonary endurance training. Low-intensity aerobic exercises such as walking or cycling 3-5 times per week for 20-30 minutes each session are advisable, maintaining a low-to-moderate intensity level.
- Adjust exercise volume according to the disease course and lung function status.
(5) FITT-VP Principle:
- Frequency: Based on current condition, recommend 1-2 daily hand function training sessions and 3-5 weekly sessions of whole-body aerobic exercise.
- Intensity: Start with low intensity and gradually increase depending on steroid use and the patient’s fatigue level.
- Time: 10-15 minutes per hand training session, 20-30 minutes for aerobic exercise.
- Type: Hand joint flexibility exercises, grip strength training, light resistance exercises, and low-impact aerobic activities.
- Progression: Increase the difficulty or duration as symptoms improve and tolerance allows.
- Volume: Complete the exercises in segments under appropriate intensity and duration, avoiding abrupt increases.

Notes: In the event of significant increases in pain or swelling, limited joint movement, or difficulty breathing, suspend exercises and consult a physician promptly. For severe bone fragility, apply caution with weight-bearing and stretching movements.

Disclaimer

This report is provided as a professional reference based on the current information and does not replace in-person consultation or professional medical advice. Specific diagnosis and treatment should be determined by specialized physicians after comprehensive clinical evaluation.