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11b - Answer: 12-year-old male presents with decreased range of motion in left elbow

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY: 

This 12-year-old male presents with chronic decreased range of motion in left elbow; patient breaks boards with his elbows.

(QUIZ ANSWER) PRIMARY FINDING: 

Hemangioma.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS:

No osseous abnormality. Growth plates open. Normal appearance of both the internal and cartilaginous external epicondyle. Normal capitellum, trochlea and radial epiphysis. 

Biceps, brachialis, triceps muscles intact. Dominant finding is region of signal alteration bright on STIR measuring 6.4cm longitudinally with several intralesional angular low signal foci or perhaps phlebolith calcifications within the brachialis that continues to the anterior joint line. This lesion has T1 signal characteristics nearly isointense nominally increased in signal intensity to skeletal muscle. Elbow joint effusion is identified. No intraarticular bodies or synovitis. 

Radial collateral, ulnar collateral ligaments intact. Lateral ulnar collateral ligament intact. Normal signal intensity involving origin tendons of both the medial and flexor extensor group. 

Normal signal within the cubital tunnel and ulnar nerve. 

CONCLUSION:

Low flow state malformation, favor hemangioma.

1. Intramuscular venous malformation involving anterior musculature above the antecubital fossa, short-axis diameter 34 x 18mm. Greater than 6cm longitudinal extension. Lesion is expected to demonstrate Doppler characteristics of increased vascularity with central phleboliths. This area should demonstrate vigorous postcontrast enhancement. In addition to soft tissue component, intramedullary malformation component is also identified and should be visible on plain film. In light of patient's inability to fully flex his elbow, consider interventional percutaneous management versus surgical debulking. 

2. Elbow joint effusion without intraarticular body. No sloppy hinge syndrome, ulnar or radial collateral ligament tear.  

3. Longitudinal intraosseous component extends in the sagittal plane roughly 4cm. 

4. In light of patient's repetitive elbow trauma as a black belt in martial arts, no intramuscular tear. No periarticular contusion; small joint effusion.

LESSON 2, TOPIC 33

Case Challenge: Elbow MRI Cases

Case Challenge

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Content reviewed: October 28, 2021

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