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This anatomical variation can pose diagnostic challenges in such patients. Based on meticulous examination and readily accessible investigations including X-rays, 12-lead ECG and ultrasound, a timely diagnosis can be made.Phalangeal microgeodic syndrome (PMS) is a rare condition typically affecting children and is characterised by painful digits precipitated by cold temperatures. In medical literature, cases appear to be clustered in Japan. Adult-onset PMS is particularly rare and although imaging features are characteristic, it m