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 19 - 55-year-old male presents with psoriatic arthritis

<div>HISTORY:&#160;This 55-year-old male presents with psoriatic arthritis with possible mass in left hand. Question sausage digit. The patient has had tumor on left index finger for six months to a year. History of hypertension.MOST LIKELY PRIMARY FINDING:&#160;Giant cell tumor of tendon sheath.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS: Beginning at the level of the A3 pulley and extending proximally for a distance of 1.77cm is a lobulated mass with some blood product staining that lies deep to and subtly surrounds the flexor mechanism. Erosion, remodeling, and invasion of the proximal phalangeal head are noted with a side-to-side dimension of 2.2cm and subtle extension around the sides of the proximal phalanx.&#160;Although there are foci of arthropathic chondral irregularity at the MCP and the DIP, these appear unrelated. Such findings may be related to the history of psoriatic arthritis.&#160;The most accessible portion of the mass lies along its ulnar margin, 1.5cm proximal to the PIP.&#160;Although the bone, itself, is invaded and remodeled, little evidence of joint invasion is identified. Still, the process circumnavigates and surrounds the palmar plate.&#160;Furthermore, extension around the digit documents dorsal compartment involvement with invasion of the extensor mechanism and oblique band, ligament or hood.&#160;IMPRESSION: Soft tissue mass with specific distribution, as described, for which the fibrohistiocytic tumor known as giant cell tumor of tendon sheath is strongly favored with a combination of bone remodeling and bone invasion, as described in the body of the report.&#160;Swelling of other digits including the third for which psoriatic and mild osteoarthritis are favored.</div>

Case

What is the most likely primary finding in this case?