Case Challenge

Stephen J Pomeranz

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

Case Review

Musculoskeletal (MSK)

Case 1 - 24-year-old female presents with history of left forearm venous malformation

Case 2 - 37-year-old female presents with pain, crepitus, and swelling of the right forearm

Case 3 - 34-year-old male pulled muscle while wakeboarding

Case 4 - 59-year-old male presents with extensive swelling at the left elbow and forearm

Case 5 - 3-year-old male presents with a left forearm mass

Case 6 - 64-year-old female presents with small lumps on the right forearm for six weeks

Case 7 - 65-year-old female presents with left forearm swelling and burning

Case 8 - 61-year-old male presents with mass at right wrist and forearm

Case 9 - 48-year-old male presents with lump on the volar right forearm for 12 years

Case 10 - 44-year-old male is being evaluated for cyst

Case 11 - 40-year-old female presents with left hand pain

Case 12 - 20-year-old male presents with crush injury of the left forearm

Case 13 - 27-year-old male is being evaluated for right forearm strain

Case 14 - 33-year-old male presents with volar right forearm mass

Case 15 - 49-year-old male presents with left elbow pain, swelling, and redness

Case 16 - 67-year-old female is being evaluated for lesion in left forearm

Case 17 - 65-year-old female presents with inability to extend thumb or fingers

Case 18 - 27-year-old female was hit in right arm by the trunk of a car

Case 19 - 70-year-old male presents with lump on right forearm

Case 20 - 58-year-old female presents with severe soft tissue swelling medial ulnar aspect

Case 21 - 59-year-old female presents with mass distal left forearm

Case 22 - 15-year-old male presents with ulnar pain in left forearm

Case 23 - 41-year-old female presents with clinical radial neuropathy

Case 24 - 2-year-old female presents with multiple osseous lesions in left forearm

Case 25 - 62-year-old male presents with paralysis of the left index finger and thumb

Course Evaluation

Post-Course Activities

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

Forearm MRI Cases

<div>HISTORY:&#160;This 49-year-old male presents with left elbow pain, swelling, and redness. Status post surgery two weeks prior. Buerger's disease.(QUIZ ANSWER) FAVORED DIAGNOSIS IN THIS CASE:&#160;Infarction and vascular insufficiency.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS: Diffuse signal intensity abnormality noted involving the pronator teres muscle of the left forearm. T1 images are hyperintense compatible with methemaglobin staining and T2 and STIR images also hyperintense compatible with edema and swelling. Smaller areas centrally demonstrate fluid signal intensity compatible with areas of liquefaction or necrotic change in the form of rounded and ovoid areas. In a patent with Buerger's disease, infarction and vascular insufficiency is favored over sickle cell anemia, defects of trauma (crush injury), DOMS or denervation syndrome. Various causes of rhabdomyolysis including drug-induced, toxic and autoimmune, diabetes are also on the differential. May also consider myositis (toxic, autoimmune, inclusion body) in the appropriate clinical setting.Milder changes in palmaris longus.No other abnormal muscles are noted.&#160;Bones demonstrate normal cancellous, endosteal and cortical compartments.&#160;&#160;Normal neurovascular bundles.&#160;CONCLUSION:&#160;Diffuse signal abnormality of the pronator teres includes methemoglobin staining and edema pattern with areas of focal liquefaction or necrosis involving the pronator teres noted which may be the sequella of vascular compromise and infarction in the appropriate clinical setting (Buerger's disease). Other conditions may include sickle cell crisis, trauma, inflammatory myopathies and myositis with connective tissue disorders, infectious myositis, diabetes and various causes of rhabdomyolysis.</div>

Case

Given the findings in this case, and the noted patient history of Buerger's disease, which of the following would be the FAVORED diagnosis?