Presentation
Hand swelling
Patient Data
There is a well-defined, lobulated mass encircles the flexor digitorum and profundus tendons of the third, fourth and fifth digits at the level of the metatarsal bones. The mass is centered at the ulnar palmar bursa. Another lesion with the same imaging appearance is noted arising from the flexor tendon sheath of the little finger.
The lesions show heterogeneous high signal intensity on T2-weighted images and intermediate signal intensity T1-weighted with mild enhancement on post-contrast images. Small foci of low signal intensity peripherally are seen most pronounced on the gradient images consistent with hemosiderin deposition. No evidence of pressure erosion on the metatarsal. Preserved bone marrow signal intensity. Normal muscle bulk and signal intensity.
There is a dense soft tissue swelling located along the radial aspect of the fifth proximal phalanx. No pressure bony erosions or focal osseous lesions are seen. Alignment is maintained.
Case Discussion
The case illustrates the typical imaging features of GCTTS involving the ulnar palmar bursa and the flexor tendon sheath of the little finger. Continuity of the radial and ulnar bursae with the 1st and 5th flexor tendon sheaths usually allow route of spread in tenosynovial disease (e.g. Infectious, inflammatory or neoplastic processes).
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