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20b - Answer: 58-year-old female presents with severe soft tissue swelling medial ulnar aspect

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

HISTORY: 

This 58-year-old female presents with severe soft tissue swelling medial ulnar aspect of the distal left forearm, present for two weeks. No known injury. Abnormal ultrasound.

(QUIZ ANSWER) LESION IS MOST LIKELY A: 

Hemangioma.

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

FINDINGS:

Findings demonstrate a soft tissue mass/lesion measuring transverse diameter of 5cm, AP diameter of 4.5cm in length (proximal to distal), 14.4cm. 

Encapsulation is variable and findings are mildly infiltrative with marked atrophy of the flexor carpi ulnaris and flexor digitorum superficialis and profundus. The lesion is high signal on T2 and low signal on T1 with well-defined lobular contours and scattered foci of decreased signal corresponding to likely calcified phleboliths, thrombosed channels or septa seen on end. 

Lesion extends as deep as the interosseous septum and is superficial as the skin surface. The lesion encases neurovascular structures including the median and ulnar nerves, anterior interosseous nerve, ulnar and radial arteries and anterior interosseous artery. Moderate infiltrative-like effect noted characterized by involvement and atrophy of the flexor carpi ulnaris and flexor digitorum superficialis and profundus. 

CONCLUSION: 

1. Large lesion occupying the anterior compartment (flexor compartment) of the forearm with lobulated contours T1 isointense to muscle and T2 hyperintense and containing foci of decreased signal intensity corresponding to likely areas of calcified phleboliths, thrombosed channels or septa seen on end. Findings compatible with cavernous hemangioma with mild to moderate infiltrative properties encasing flexor compartment muscles and neurovascular structures including radial artery, ulnar artery, anterior interosseous artery and radial and ulnar nerves and anterior interosseous nerve. Full extent of the lesion is approximately 5 x 4.5 x 14.4cm (transverse, AP and proximal to distal). 

2. No evidence for cortical or cancellous infiltration or involvement.

LESSON 2, TOPIC 60

Case Challenge: Forearm MRI Cases

Case Challenge

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Content reviewed: July 19, 2021

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