Learning objectives
I) To recognize the imaging features of pseudotumoral lesions of the soft tissues of hand. II)To differentiate pseudotumours from true neoplasms.
Background
Pseudotumoral lesions of the hand are those bearing close resemblance or mimics the appearance of tumours of the hand. Recognizing tumour mimics are of utmost importance,
as they are more common than their neoplastic counterparts and most of these lesions are incidental,
reactive or self-limiting1.
Very often that pseudotumoral lesions are mistaken for benign or malignant neoplasms resulting in unwarrented biopsies and other surgical interventions.
The pathogenesis of each of these pseudotumoural lesions is very different and rather interesting.
This case series aims at describing...
Imaging findings OR Procedure Details
Pseudotumoral lesions include a large & heterogeneous group of disorders and can be broadly classified1into following categories:
1. Normal anatomical variants.
2. Hamartomatous lesions:
Lipofibromatous hamartoma (LFH) of median nerve
3. Cysts and cyst like lesions;
Synovial cyst,
ganglion cyst and tendon sheath cyst
4. Infectious lesions:
5. Non infective- inflammatory lesions:
Inflammatory tenosynovitis,
Rheumatoid nodules,
Subcutaneous granuloma annulare,
Synovial osteochondromatosis.
Drug induced synovitis.
6. Post-traumatic lesions:
Epidermal inclusion cysts,
Myositis ossificans,
Foreign Body ( FB) granuloma,
Post-traumatic tenosynovitis / micro-vascular pseudo-aneurysm
7. Non-neoplastic vascular...
Conclusion
The importance of clinical history cannot be overstated,
in the evaluation of these pseudo-tumoural lesions of the hand, as most of these lesions may have an ‘inciting’ or ‘precipitating factor’.
A dedicated high resolution imaging protocol ,
tailored made imaging techniques,
according to the clinical scenario should be implemented .
Dynamic contrast imaging should be done wherever necessary,
especially in cases of traumatic injuries and in other cases of suspected vascular involvement without which major findings would be missed.
In this exhibit,
inflammatory –non infective...
References
1) Vanhoenacker FM,
Eyselbergs M,
Hul EV,
Dyck PV,
Schepper AMD.
Pseudotumoural soft tissue lesions of the hand and wrist: a pictorial review.
Insights into Imaging.
2011;2(3):319–33.
2) Freire VCA,
Guérini H,
Campagna R,
Moutounet L,
Dumontier C,
Feydy A,
et al.
Imaging of Hand and Wrist Cysts: A Clinical Approach.
American Journal of Roentgenology.
2012;199(5).
3) Bermejo A,
Bustamante TDD,
Martinez A,
Carrera R,
Zabía E,
Manjón P.
MR Imaging in the Evaluation of Cystic-appearing Soft-Tissue Masses of the Extremities.
RadioGraphics.
2013;33(3):833–55.
4) Patel...
Personal Information
Dr.
NATESAN CHIDAMBARANATHAN,
MD,
PhD,
DNB,
DMRD,
FICR,
MAMS
Head of Department of Radiology & Imaging ,
Apollo Hospitals,
21,
Greams lane,
Chennai -60006 ,
INDIA
Mobile : +91 9840031045,
Phone +9144 2829 05 80
E mail :
[email protected]