Hospital For Special Surgery:What's the Diagnosis - Case 54

What’s the Diagnosis – Case 54

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What’s the Diagnosis – Case 54

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What’s the Diagnosis – Case 54

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What’s the Diagnosis – Case 54

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What’s the Diagnosis – Case 54

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What’s the Diagnosis – Case 54

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What’s the Diagnosis – Case 54

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What’s the Diagnosis – Case 54

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Findings: Radiographs demonstrate soft tissue calcifications with areas of central lucency or lamellation seen within the calcifications. MRI demonstrates a high signal proton density (PD) and inversion recovery (IR) mass with a lobulated or somewhat tubular type architecture. Particularly on the gradient echo sequence, well seen are thin, internal, low signal septae as well as rounded areas of particularly low signal. These areas correlate with the calcifications of the radiographs. Although, the mass is well demarcated, it does cause an effacement of the fat of the ulnar nerve as it traverses the heads of the flexor carpi ulnaris (FCU).

What’s the Diagnosis – Case 54

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What’s the Diagnosis – Case 54

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What’s the Diagnosis – Case 54

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What’s the Diagnosis – Case 54

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What’s the Diagnosis – Case 54

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What’s the Diagnosis – Case 54

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What’s the Diagnosis – Case 54

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Diagnosis: Vascular Malformation The generic term of vascular malformation is given as the diagnosis as there is still debate about how to appropriately term these lesions. The term hemangioma is often used to describe a capillary or smaller vessel lesion that is seen of the superficial soft tissue in very young children and typically involutes by 4 to 5 years of age. The lesion shown here is described by some as a cavernous type hemangioma and by others as a venous malformation. In either way, it represents larger, dilated blood channels with slow flowing blood. These are often somewhat more deep seated and may become painful with activity. These lesions as in this case, often will show a high signal, tubular architecture corresponding to the slow flowing blood in the dilated vascular channels. The calcifications or phleboliths at times will show a characteristic, lamellated pattern as in this case with a central lucency. These masses are often well demarcated but at times will be somewhat more poorly marginated. Areas of fat may be seen interspersed within these masses. If painful these masses may be resected or as in this case their mass effect may necessitate resection.

Although, not malignant, recurrence rates can be seen in up to 25% depending on the margins at excision.

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Resources: •

Magnetic resonance imaging of benign soft tissue neoplasms in adults.

Walker EA, Fenton ME, Salesky JS, Murphey MD.Radiol Clin North Am. 2011 Nov;49(6):1197-217.

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MR imaging of soft-tissue vascular malformations: diagnosis, classification, and therapy follow-up. Flors L, Leiva-Salinas C, Maged IM, Norton PT, Matsumoto AH, Angle JF, Hugo Bonatti M, Park AW, Ahmad EA, Bozlar U, Housseini AM, Huerta TE, Hagspiel KD.Radiographics.

2011 Sep-Oct;31(5):1321-40; discussion 1340-1.

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Resnick. Diagnosis of Bone and Joint Disorders. 4th Ed. 2002.

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