Letters
Call a Spade a Spade
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Every year at this time, frantic fourth-year residents are busy learning all the “buzz words” and radiologic manifestations of many diseases that most of them have never seen during their daily clinical work. Recently, residents at our institution viewed a film on the hand that showed the classic manifestations of acromegaly. The tuftal hypertrophy was identified, and one resident happily described the finding as the classic “spade-shaped” phalanges.
The finding of tuftal hypertrophy is certainly associated with acromegaly and has been described extensively in the literature [1]. However, “spade-shaped” refers to the enlargement of the hand caused by both soft-tissue and osseous enlargement, not to enlargement of the phalanges. This term was coined by Marie [2] in 1886 before the discovery of X rays, and it refers to the garden spade (Fig. 2A), not the playing card symbol (Fig. 2B). Interestingly, my own musculoskeletal colleagues hold varying opinions on the true meaning of spade-shaped. These opinions highly correlate with whether they are gardeners. I find it amusing that this clinical description, coined before the discovery of X rays, was misinterpreted by some unknowing radiologist along the way and now has proliferated in the minds of radiologists and even in the pages of radiology textbooks. I hope this short letter sets the record straight.
 View larger version (9K) | Fig. 2A. —Drawings illustrate typical appearance of gardening spade (A) and spade symbol used on playing cards (B). |
 View larger version (12K) | Fig. 2B. —Drawings illustrate typical appearance of gardening spade (A) and spade symbol used on playing cards (B). |
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