78-year-old male with a mass in the distal aspect of the thumb

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Case History

Swelling and pus. Status post removal of infected fingernail.

Technical Factors

Long- and short-axis fat- and water-weighted images were performed; 1.5T High Field Oval.

Case Findings

Images performed with a dedicated microcoil.
Fluid collection is seen distally at the thumb roughly 11mm in diameter. Marked cortical destruction of the distal phalanx with osseous edema extending to the IP joint of the thumb. Swelling of both radial and lateral collateral ligament fibers. Although subtle foci of distal epiphyseal proton-density signal hyperintensity proximal phalanx of the thumb noted with preserved T1 signal intensity subcutaneous edema extends towards the distal diaphysis of the thumb in the proximal phalanx.

Case Conclusion

Distal subcutaneous fluid collection. Osteomyelitis distal phalanx of the thumb without IP joint space effusion. Foci of proton-density signal hyperintensity within the head proximal phalanx without associated T1 signal change favor regional edema without osteomyelitis.
Imaging performed in the dedicated microcoil.
Patient refused IV contrast administration but none needed.
No tenosynovitis extending towards the MCP articulation.

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