Presentation
Painless swelling of the right hand on the thener space, no local tenderness, full ROM.
Patient Data
A well defined soft tissue swelling is noted overlying the first and second metacarpal space.
There is a large lipoma is noted just distally to carpal tunnel among flexors tendons and extending distally in the metacarpal space showing displacing without invasion, eliciting a homogeneous mass, with a sharp border, T1 and T2 hypersignals, subtracted signal intensity after fat signal subtraction and no contrast enhancement after gadolinium contrast agent injection, the mass measure about 5.5 x 3.0 cm in maximum dimension.
The median nerve shows a very subtle flattening shape.
Flexor retinaculum: Normal.
Flexor tendons: are displaced by the mass and appear normal shape and intensity
Bone alignment and marrow: show mild degenerative changes in the form of subcortical tiny cystic changes.
IMPRESSION:
Features suggestive of giant lipoma at the hand with extension as mentioned above.
Case Discussion
This good example and typical MRI features of giant lipoma at the hand with its extension and relation to the surrounding structures. MRI is the modality of choice for the diagnosis of lipomas.