Ultrasound, diagnostic Case Photo #1:
Hyperechoic mass identified on short and long axis, appearing underneath the flexor retinaculum, seemingly from the flexor digitorum profundus or superficialis. The mass is ovoid, measuring 2.09cm in length, with a cross-sectional diameter of 0.73cm x 0.56cm. Mild surrounding hyperechoic change.
On dynamic ultrasound, the mass can be clearly visualized moving beneath the retinaculum as fingers are flexed, reproducing physical exam findings.
X-rays Case Photo #2, Case Photo #3:
MRI Case Photo #4, Case Photo #5, Case Photo #6, Case Photo #7:
9 x 8 x 18mm ovoid well-defined mass arising from the distal carpal tunnel, lying anterior to the flexor digitorum profundus tendon at the level of the 3rd metacarpal base. High signal fatty component within the mass and nodular to linear areas of intermediate signal. Mild surrounding peripheral capsular enhancement. Normal bone marrow signal. Probable fibrolipomatous hamartoma, soft tissue hemangioma unlikely.
The patient was initially referred to orthopedic oncology to discuss surgical options, including biopsy and/or complete excision.
Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.