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16b - Answer: 78-year-old male presents with swelling and pus

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 swelling and pus. Status post removal of infected fingernail, right hand.

(QUIZ ANSWER) IS A FINDING 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:

Images performed with a dedicated microcoil.

Fluid collection is seen distally at the thumb, roughly 11mm in diameter. Marked cortical destruction of the distal phalanx with osseous edema extending to the IP joint of the thumb. Swelling of both radial and lateral collateral ligament fibers. Although subtle, foci of distal epiphyseal proton-density signal hyperintensity proximal phalanx of the thumb noted with preserved T1 signal intensity, subcutaneous edema extends towards the distal diaphysis of the thumb in the proximal phalanx. 

CONCLUSION: 

1. Distal subcutaneous fluid collection. Osteomyelitis distal phalanx of the thumb without IP joint space effusion. Foci of proton-density signal hyperintensity within the head proximal phalanx without associated T1 signal change, favor regional edema without osteomyelitis. 

2. Imaging performed in the dedicated microcoil. 

3. Patient refused IV contrast administration, but none needed. 

4. No tenosynovitis extending towards the MCP articulation.

LESSON 2, TOPIC 48

Case Challenge: Thumb & Finger MRI Cases

Case Challenge

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Content reviewed: October 27, 2021

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