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 40-year-old female presents with left hand pain, disturbance of skin sensation, loss of use of the thumb, and some loss of use of the 1st finger. No known injury.(QUIZ ANSWER) DIFFERENTIAL THAT CAN BE EXCLUDED IN THIS CASE:&#160;Crush injury.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS: Bones about the elbow and forearm are intact with no occult fracture or stress fracture. Mild arthropathic change with bony spurring and chondromalacia with a small erosion around the radiocapitellar articulation medially. Small amount of capsular fluid. No osteochondral defect or loose bodies. No noted mass, cyst or ganglion about the elbow.&#160;Common flexor and extensor tendons are intact with no evidence of epicondylitis. Radial and ulnar collateral ligaments are intact.&#160;The visualized portions of the ulnar nerve within the forearm are unremarkable. The visualized portions of the radial nerve are unremarkable within the forearm.The median nerve appears relatively normal within the upper arm without evidence for supracondylar process or Struthers' ligament. The median nerve becomes hyperintense on T2-weighted imaging as it enters the antecubital fossa deep to the lacertus fibrosus with suggestion of compression between the superficial and deep heads of the pronator teres with thickening and hyperintensity distal to the region of suspected compression. The hyperintensity continues distally into the forearm near the level of the wrist, as well as slowly returning to a normal caliber.Patchy abnormal increased signal intensity on the water weighted sequences within the pronator teres, flexor carpi radialis, palmaris longus, flexor digitorum superficialis, radial aspect of the flexor digitorum profundus and flexor pollicis longus. The flexor carpi ulnaris is spared suggesting denervation from a median nerve entrapment.&#160;Diffuse edema is noted within the subcutaneous soft tissues. No other abnormal signal is seen within the musculature of the forearm.&#160;CONCLUSION: Unexplained atraumatic muscular neural and subcutis swelling - Differential diagnosis includes polyneuritis multiplex as in connective tissues diseases; full blown RSD; perineoplastic or poems syndrome as might occur with plasma cell dyscrasia; and excluded based on history alone is a crush injury.1a. Thickening and hyperintensity of the median nerve at the level of the antecubital fossa likely due to compression between the heads of the pronator teres muscle with patchy signal alteration seen within the pronator teres, flexor carpi radialis, peroneus longus, flexor digitorum superficialis, radial flexor digitorum profundus and flexor pollicis longus consistent with median nerve entrapment or pronator teres syndrome.&#160;1b. Lesser degrees of swelling involving the ulnar nerve.2. Mild arthropathic change within the elbow.&#160;3. Mild subcutaneous edema within the soft tissues of the forearm.</div>

Case

Polyneuritis multiplex (as in connective tissues diseases)

Full blown reflex sympathetic dystrophy (RSD)

Perineoplastic or Poems syndrome (as might occur with plasma cell dyscrasia)

In this case, there is unexplained atraumatic muscular neural and subcutis swelling. Which of the following differentials can be excluded based on history alone?