EURORAD ESR

Case 10091

Tuberculous Tenosynovitis - Anyone for Rice?

Author(s)
Bickle, IC*, Lim, ECC, Joseph, V
* Consultant Radiologist
RIPAS Hospital, BSB, Brunei

RIPAS Hospitsl, BSB, Brunei

ian@bickle.co.uk
 
Patient
male, 48 year(s)
 
 
  • Figure 1
    Clinical Images: Presentation

    Hand at presentation with apparent multifocal palmar mass

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: Image manipulation / Reconstruction; Procedure: Perception image; Special Focus: Infection;
     
     
  • Figure 2
    MRI Hand: T1
     

    T1 coronal: Signal void tendons pass uninturrupted through the isointense mass on the palmar surface of the hand

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;

    Axial T1 Sequence: Well circumscribed palmar mass, with tendons running centrally within, suggesting it is contained within the synovial sheath

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 3
    MRI Hand: T2
     

    T2 Coronal Sequence: 'Honeycomb' appearance of the mass related to the middle finger, with the multiple 'rice bodies' well delineated within

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;

    T2 Axial Sequence: 'Honeycomb' appearance of the mass related to the middle finger, with tendons running centrally within.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 4
    MRI Hand: TIRM and Post Contrast Sequences
     

    Coronal TIRM - 'Rice bodies' clearly delineated

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;

    Coronal Post Contrast: Minimal, largely peripheral contrast enhancement of the mass

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;

    Axial Post Contrast: peripheral enhancment demonstrated

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 5
    Clinical Images: Intra-Operative
     

    Intra-operative image with the palmar mass exposed

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: Experimental; Procedure: Intraoperative; Special Focus: Infection;

    The content of the mass is revealed showing 'rice bodies' adjacent to the tendon

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: Experimental; Procedure: Intraoperative; Special Focus: Infection;
     
     
  • Figure 6
    Histopathological specimen
     

    Nodular aggregates of fibrin containing rare lymphocytes and epithelioid histiocytes

     
    Area of Interest: Musculoskeletal system; Imaging Technique: Image manipulation / Reconstruction; Procedure: Biopsy; Special Focus: Infection;

    Caseating grauloma typical of tuberculosis

     
    Area of Interest: Musculoskeletal system; Imaging Technique: Image manipulation / Reconstruction; Procedure: Biopsy; Special Focus: Infection;

    AFFB on Ziel Nielsen stain

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: Image manipulation / Reconstruction; Procedure: Biopsy; Special Focus: Infection;
     
     
Hand at presentation with apparent multifocal palmar mass
 
T1 coronal: Signal void tendons pass uninturrupted through the isointense mass on the palmar surface of the hand
 
Axial T1 Sequence: Well circumscribed palmar mass, with tendons running centrally within, suggesting it is contained within the synovial sheath
 
T2 Coronal Sequence: 'Honeycomb' appearance of the mass related to the middle finger, with the multiple 'rice bodies' well delineated within
 
T2 Axial Sequence: 'Honeycomb' appearance of the mass related to the middle finger, with tendons running centrally within.
 
Coronal TIRM - 'Rice bodies' clearly delineated
 
Coronal Post Contrast: Minimal, largely peripheral contrast enhancement of the mass
 
Axial Post Contrast: peripheral enhancment demonstrated
 
Intra-operative image with the palmar mass exposed
 
The content of the mass is revealed showing 'rice bodies' adjacent to the tendon
 
Nodular aggregates of fibrin containing rare lymphocytes and epithelioid histiocytes
 
Caseating grauloma typical of tuberculosis
 
AFFB on Ziel Nielsen stain
 
 
 
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