Tendon sheath lipoma
Painless swelling in hand of chronic duration
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Well defined lobulated mass seen insinuating between the flexor tendons that is composed of fat, supression seen on fat sat images consistent with a lipoma.
True discrete tendon sheath lipomas are rare
Usually hand is the most common site.
Other than soft tissue lipoma, lipomas in MSK can manifest as: true tendon sheath/joint lipoma (such as this case) and lipoma arborescens.