Presentation
Presented with left wrist / distal most forearm palmar region swelling, tingling in hand for about last one month. No trauma. Normal finger movements.
Patient Data
There is a well-defined lobulated lesion in the region of interest.
Size
- Cranio-caudal - 20 mm
- Axial - 16 mm
- Antero-posterior - 11 mm
Location
- Proximal to carpal tunnel
- Flexure pollocis longus( FPL ) myotendinous junction abutts radial side of the lesion.
- The median nerve is elevated and mildly laterally displaced by the lesion.
- Index finger flexure tendon is deep to the lesion.
- Palmar cutaneous branch of the median nerve is superficial to the lesion.
- Hyperechoic fat abutts ends of the lesion.
Morphology
- Solid
- Heterogeneous Hypoechoic
- No calcification / cystic changes.
- Small lobulations present
- Posterior acoustic enhancement present
- Not compressible
Doppler
- Few flow signals are present in the peripheral part of the lesion.
Dynamic scan
- Tendons show free movement from the lesion.
Median nerve
- No edema proximal to tunnel
- No obvious fascicle thickening near the lesion
The lesion is solid. It is in close relation to the deeper flexure tendon.
Case Discussion
A young female presented with a lump in distal forearm/wrist region on the palmar side. Ultrasound shows a well-defined, solid lesion which is free from the tendons. Surgical excision of the tumor was done. Histopathology revealed the lesion being a giant cell tumor of the tendon sheath.
Intraoperative photos courtesy: Operating surgeon Dr. Pinkesh V. Patel & Dr. Vitrag D. Shah.
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