Case Challenge

Stephen J Pomeranz

Gain confidence interpreting Forearm MRI Cases with MRI Online. Quiz yourself using real-world, interactive scrollable cases & earn CME. Try it free!

Case Review

Musculoskeletal (MSK)

Case 1 - 24-year-old female presents with history of left forearm venous malformation

Case 2 - 37-year-old female presents with pain, crepitus, and swelling of the right forearm

Case 3 - 34-year-old male pulled muscle while wakeboarding

Case 4 - 59-year-old male presents with extensive swelling at the left elbow and forearm

Case 5 - 3-year-old male presents with a left forearm mass

Case 6 - 64-year-old female presents with small lumps on the right forearm for six weeks

Case 7 - 65-year-old female presents with left forearm swelling and burning

Case 8 - 61-year-old male presents with mass at right wrist and forearm

Case 9 - 48-year-old male presents with lump on the volar right forearm for 12 years

Case 10 - 44-year-old male is being evaluated for cyst

Case 11 - 40-year-old female presents with left hand pain

Case 12 - 20-year-old male presents with crush injury of the left forearm

Case 13 - 27-year-old male is being evaluated for right forearm strain

Case 14 - 33-year-old male presents with volar right forearm mass

Case 15 - 49-year-old male presents with left elbow pain, swelling, and redness

Case 16 - 67-year-old female is being evaluated for lesion in left forearm

Case 17 - 65-year-old female presents with inability to extend thumb or fingers

Case 18 - 27-year-old female was hit in right arm by the trunk of a car

Case 19 - 70-year-old male presents with lump on right forearm

Case 20 - 58-year-old female presents with severe soft tissue swelling medial ulnar aspect

Case 21 - 59-year-old female presents with mass distal left forearm

Case 22 - 15-year-old male presents with ulnar pain in left forearm

Case 23 - 41-year-old female presents with clinical radial neuropathy

Case 24 - 2-year-old female presents with multiple osseous lesions in left forearm

Case 25 - 62-year-old male presents with paralysis of the left index finger and thumb

Course Evaluation

Post-Course Activities

This Power Pack is comprised of 25 unique Forearm MRI cases that you can scroll through in our diagnostic web viewer to determine your findings. Quiz yourself and earn CME.

Forearm MRI Cases

<div>HISTORY:&#160;This 24-year-old female presents with history of left forearm venous malformation status post multiple episodes of sclerotherapy. Interventional radiology note describes a lesion extending within deep and superficial portions of the left forearm from above the elbow to the wrist. The IR note described related ulnar neuropathy.(QUIZ ANSWER) AN ACCURATE STATEMENT IN THIS CASE:&#160;The malformation has very little residual postcontrast enhancement.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS: Within the volar forearm and with associated intraosseous bridging into the volar ulna extending roughly 4.5cm, there is a mixed signal intensity lesion predominantly isoechoic to muscle on T1 with scattered marginal fat signal and lobular multicentric intermediate- and hyperintense T2 foci with overall dimension 35 x 25mm in short axis and long axis diameter of roughly 18cm with a few posterior, deep compartment components measuring 14mm longitudinally, 10 x 3mm in short axis.&#160;Following contrast administration, there is wispy faint marginal enhancement without significant central enhancement noted. Note, the postcontrast data set is performed without fat-saturation which is suboptimal technically.&#160;Importantly, the lesion spares the radial aspect of the forearm and the radial periosteal regions.&#160;No subcutaneous component.&#160;CONCLUSION:&#160;1. Large, both intraosseous and predominantly intramuscular forearm vascular (cavernovenous) malformation which has very little residual postcontrast enhancement. No enhancing venous lakes apparent and no muscular features to suggest compartment syndrome.&#160;2. Importantly, the lesion is intimately associated with the midforearm ulnar nerve and infiltrates at the flexor digitorum musculature with preservation of the majority of the flexor digitorum superficialis and flexor carpi ulnaris. In the proximal forearm portions of the mass track along the course of and compress the ulnar nerve. Median nerve and radial tunnel are spared. Please check patient for macrodactyly as in macrodystrophia lipomatosa, proteus syndrome, and Klippel-Trenaunay-Weber syndrome.</div>

Case

The malformation has very little residual postcontrast enhancement.

There are enhancing venous lakes apparent.

There are muscular features to suggest compartment syndrome.

In this case, there is a large, both intraosseous and predominantly intramuscular, forearm vascular (cavernovenous) malformation. Regarding this, which of the following IS an accurate statement?