Case Challenge

Hand & Wrist

Stephen J Pomeranz

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

Case Review

Musculoskeletal (MSK)

Post-Course Activities

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

Hand MRI Cases

Case 10 - 61-year-old female presents with a mass on the right hand

<div>HISTORY:&#160;This 61-year-old female presents with a mass on the dorsal right hand.THERE ARE NO CHARACTERISTICS TO SUGGEST:&#160;Chondrosarcoma.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS: Multifocal areas of ectopic ossification are present surrounding the 3rd digit. The foci are innumerable and occupy the dorsal capsule. One lies along the radial aspect of the capsule under the extensor tendon oblique band measuring approximately 4mm. Another more proximal along the distal diaphysis is also ossified and measures 7.5 x 5.9mm and resides in the interosseous muscles. A third more distal area intracapsular residing on the dorsal capsule of the proximal phalanx is more multifocal yet the side-to-side dimension of the three areas of ossific interest is almost a centimeter.&#160;On the ulnar side are at least four areas of mass some chondral and some chondroosseous which measure approximately 7.5mm each and are four in number.&#160;Favor the diagnosis of intra- and extraarticular synovial osteochondromatosis and synovial chondromatosis.&#160;Soft tissue chondroma based on the size and geography would be a less likely consideration.&#160;As no direct communication with the bone itself is discerned, juxtacortical chondroma or chondral lesion arising directly from the bone seems unlikely but plain film is requested for corroboration in this regard as there are subtle areas of periosteal nonaggressive reaction.&#160;The joint of the 3rd digit is arthropathic with subchondral pseudocysts and swelling.&#160;No other joint appears involved.&#160;CONCLUSION:&#160;Ossific- and chondral-appearing masses of varying size and number described in the body of the report associated with an arthropathic joint the majority of which are intraarticular and the diagnosis of synovial osteochondromatosis and chondromatosis both intraarticular- and soft tissue-related are favored over a primary chondroid lesion. Still, there are no characteristics to suggest an aggressive process such as a chondrosarcoma. Entities such as primary juxtacortical multifocal chondromas, turret exostoses, soft tissue chondroma, and multifocal osteochondromas were all considered in the differential.</div>

Case

Primary juxtacortical multifocal chondromas

There are no characteristics to suggest which of the following potential differentials?