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 21 - 55-year-old female presents with small mass on left hand ring finger

<div>HISTORY:&#160;This 55-year-old female presents with a small mass on the left hand ring finger.LEAST LIKELY DIFFERENTIAL:Tendon sheath giant cell tumor.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS: A 6 x 6mm well-defined nonaggressive lesion is demonstrated in the lateral and ventral aspect of the 4th proximal phalangeal shaft. It contacts the adjacent bone and flexor tendon. However, it does not appear to scallop or destruct bone or invade or infiltrate the tendon. It shows low signal on T1-weighted image and high signal on T2-weighted images.&#160;A tiny subchondral pseudocyst or osteoedema is demonstrated at the base of the 1st middle phalanx. Otherwise, no arthropathy or stress-induced osteoedema is demonstrated interphalangeal joint or metacarpophalangeal joints. No joint effusion is present.&#160;The lateral collateral ligamentous evaluation limited due to high signal of the small lesion at the 4th proximal phalangeal joint. Otherwise, collateral ligaments are intact. Flexor and extensor tendons are unremarkable. No soft tissue swelling or fluid collection is demonstrated. No muscle atrophy or myoedema is seen. No fracture or subluxation. No bony deformities seen. No marginal erosions or hyperemia is demonstrated along the joints.&#160;CONCLUSION:&#160;A 6 x 6mm nonaggressive well defined lesion in the radial and ventral aspect of the 4th proximal phalangeal distal shaft without bony scalloping or destruction or infiltrating or invading to the tendon. Differential diagnosis includes a ganglion pseudocyst, synovial cyst, epidermal inclusion cyst, hemangioma and lymphangioma. Tendon sheath giant cell tumor is less likely due to its high signal on T2-weighted image. Although, GCTS may not always be pigmented.</div>

Case

Which of the following is the least likely differential in this case?