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Basil J. Zitelli, MD
Author Affiliations: The Paul C. Gaffney Diagnostic Referral Service, Department of Pediatrics, Children’s Hospital of Pittsburgh, Pittsburgh, Pa.

Arch Pediatr Adolesc Med. 2005;159:721.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

A 28-year-old man presented with numerous musculoskeletal findings, the following of which were noted (Figure 1): in the head and neck: dolichocephaly, malar hypoplasia, highly arched palate, retrognathia, and ectopia lentis with iridodonesis; in the extremities: long limbs (dolichostenomelia), long, tapered fingers (arachnodactyly), contractures of several joints, and pes planus, as well as "thumb sign" (Figure 2) and "wrist sign" (Figure 3); and in the torso: pectus carinatum, scoliosis, and striae atrophicae. His medical history was notable for spontaneous pneumothorax and aortic root dilatation.

Figure appears in full text version. Figure 1. Physical findings in a 28-year-old man.

Figure appears in full text version. Figure 2. "Thumb sign": when the hand is clenched without assistance, the entire thumbnail projects beyond the border of the hand.

Figure appears in full text version. Figure 3. "Wrist sign": when the wrist is grasped by the contralateral hand, the thumb overlaps the terminal phalanx of the fifth digit.

What is your diagnosis?

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