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The “thumb and wrist sign” in Marfan syndrome
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A 16 year old male presented with dilatation of the ascending aorta (41 mm) and mitral valve prolapse. As shown below, the thumb protruded from the clenched fist and the wrist sign was also evident. Arachnodactily and loose joints account for the ability to position the fingers in this ways.

 The patient also had other features of Marfan syndrome, including family history, excessive height, span of the arms exceeding height, scoliosis of the spine, dilatation of the dural sac of the lumbar spine, a high arched palate, and ectopia lentis. Treatment with a β blocker has been initiated.