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12b - Answer: 78-year-old male presents with right elbow mass

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

HISTORY: 

This 78-year-old male presents with a right elbow mass.

(QUIZ ANSWER) A LIKELY DIFFERENTIAL IN THIS CASE: 

Gout.

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

FINDINGS:

Mass measuring 4.2cm transverse x 2.7cm craniocaudal x 0.9cm AP is noted in the distribution of the olecranon bursa characterized as a fluid collection with moderate irregular rim enhancement upon gadolinium infusion. Surrounding soft swelling noted.

Intact tendinous and muscular attachments of all three components of the triceps tendon insertion. 

No evidence for underlying bony erosion, destruction marrow edema or osteomyelitis. 

No evidence for joint effusion. 

No macrofracture or microtrabecular injury. 

Normal biceps and brachialis tendons. 

Normal medial and lateral tendon and ligament complexes. 

Normal ulnar, median, and radial nerve branches. 

Normal elbow alignment and configuration. 

Normal musculature.

Differential includes gout being the most likely consideration and septic olecranon bursitis less likely with additional diagnostic considerations including repeated trauma, occupational bursitis, student's elbow, miner's elbow, although clinically infection must be excluded. Consider needle aspiration for crystals, culture and sensitivity, gram stain, and synovial fluid analysis. 

IMPRESSION:

Distention of the olecranon bursa with irregular surrounding rim enhancement and surrounding soft tissue swelling measuring 4.2 x 2.7 x 0.9cm compatible with inflammation, gout being the most likely consideration; septic olecranon bursitis is less likely. Consider needle aspiration for crystals, culture and sensitivity, gram stain, and synovial fluid analysis. 

Bony structures are intact without evidence for underlying osteomyelitis within the olecranon or other cortical or marrow abnormality. 

Intact tendinous and muscular components of the triceps tendon insertion and no evidence for joint effusion. 

No evidence for internal derangement. 

Thank you for your referral in this case.

LESSON 2, TOPIC 36

Case Challenge: Elbow MRI Cases

Case Challenge

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Content reviewed: October 28, 2021

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