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

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

HISTORY: 

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

(QUIZ ANSWER) POTENTIAL DIFFERENTIAL DIAGNOSIS IN THIS CASE: 

All of the above.

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

FINDINGS:

The bones are in anatomic alignment. The bone marrow signal is normal without evidence of occult fracture, stress fracture or bone contusion. Mild elbow joint arthrosis noted. Bone fragments are seen adjacent to the medial epicondyle suggesting remote injury/old avulsion fracture. Mild wrist arthrosis also noted with small radioulnar joint effusion. A volar cystic lesion is noted extending from the ulnocarpal articulation, possibly representing a small ganglion or capsulobursal cyst. 

The visualized muscles are intact. No evidence of hemorrhage, tear or strain. 

The visualized tendons are without abnormality. 

Multiple ill-defined, subcutaneous, low T1 and T2 signal lesions are noted extending along the dorsal forearm, predominantly medially, with several lesions also noted anterolaterally at the level of the wrist. Differential diagnosis includes amyloid deposits, fibromatosis, and multiple desmoids. 

CONCLUSION: 

1. Multiple, ill-defined subcutaneous lesions all along the forearm predominantly dorsomedially with several lesions anterolaterally at the level of the wrist for which the differential diagnosis includes erythema nodosum, multifocal immune-mediated nodular fasciitis, proliferative fasciitis and less likely sarcoid, amyloid deposits, fibromatosis (unlikely) and multiple desmoids. Tissue sampling recommended. 

2. Moderate elbow arthrosis, with suggestion of remote avulsion injury of the medial epicondyle. 

3. Moderate wrist arthrosis with small radioulnar effusion and small volar ulnocarpal capsulobursal cyst or ganglion.

LESSON 2, TOPIC 18

Case Challenge: Forearm MRI Cases

Case Challenge

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Content reviewed: July 19, 2021

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