EURORAD ESR

Case 15136

A rare case of intraneural venous malformation of the median nerve[1] causing carpal tunnel syndrome

Author(s)
Samson Kade1, Harisha V1, Sharath Kumar GG1, Ashish Rudrawadi1, Swarna Shivakumar2

1.Radiologist, Department of radiology and imaging sciences, Apollo Speciality Hospital, Bangalore -560011
2.Pathologist, Department of pathology, Apollo Speciality Hospital, Bangalore -560011

Apollo Speciality Hospital ; Jayanagar 560011 Bangalore , India; Email:drsam03bmc@gmail.com
 
Patient
male, 26 year(s)
 
 
  • Figure 1
    X-RAY OF RIGHT WRIST AP AND LATERAL VIEW
     

    Plain radiograph of right wrist AP view shows no obvious abnormality. No soft tissue calcification/phlebolith. .

     
    Area of Interest: Musculoskeletal system; Imaging Technique: Plain radiographic studies; Procedure: Education; Special Focus: Calcifications / Calculi;

    Plain radiograph of right wrist lateral view shows no obvious abnormality. No soft tissue calcification/phlebolith. .

     
    Area of Interest: Musculoskeletal system; Imaging Technique: Plain radiographic studies; Procedure: Education; Special Focus: Calcifications / Calculi;
     
     
  • Figure 2
    Axial and coronal T1W images
     

    Axial T1W image shows iso to high signal intensity lesion in median nerve at carpal tunnel

     
    Area of Interest: Neuroradiology peripheral nerve; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Arteriovenous malformations;

    Coronal T1W image shows iso to high signal intensity lesion in median nerve at carpal tunnel region.

     
    Area of Interest: Neuroradiology peripheral nerve; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Arteriovenous malformations;
     
     
  • Figure 3
    Axial T2W image

    Axial T2W image shows high signal intensity lesion in median nerve in carpal tunnel region.

     
    Area of Interest: Musculoskeletal system; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Arteriovenous malformations;
     
     
  • Figure 4
    Axial STIR image

    Axial STIR image shows high signal intensity lesion within median nerve at carpal tunnel.

     
    Area of Interest: Neuroradiology peripheral nerve; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Arteriovenous malformations;
     
     
  • Figure 5
    Axial and coronal gradient echo(GRE) image.
     

    Axial gradient echo(GRE) image shows blooming within lesion suggestive of intralesional hemorrhage.

     
    Area of Interest: Neuroradiology peripheral nerve; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Arteriovenous malformations;

    Coronal gradient echo(GRE) image shows blooming within lesion suggestive of intralesional hemorrhage.

     
    Area of Interest: Neuroradiology peripheral nerve; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Arteriovenous malformations;
     
     
  • Figure 6
    Coronal,axial and sagittal contrast enhanced images
     

    Coronal contrast enhanced Fat Sat image of wrist demonstrated significant heterogenous enhancement of the intraneural lesion of median nerve at carpal tunnel region.

     
    Area of Interest: Neuroradiology peripheral nerve; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Arteriovenous malformations;

    Axial contrast enhanced Fat Sat image of wrist demonstrated significant heterogenous enhancement of the intraneural lesion of median nerve at carpal tunnel region.

     
    Area of Interest: Neuroradiology peripheral nerve; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Arteriovenous malformations;

    Sagittal contrast enhanced Fat Sat image of wrist demonstrated significant heterogenous enhancement of the intraneural lesion of median nerve at carpal tunnel region

     
    Area of Interest: Neuroradiology peripheral nerve; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Arteriovenous malformations;
     
     
  • Figure 7
    Intraoperative view of lesion
     

    Intraoperative image showed bluish lesion within median nerve.

     
    Area of Interest: Neuroradiology peripheral nerve; Imaging Technique: PACS; Procedure: Surgery; Special Focus: Arteriovenous malformations;

    Intraoperative surgical exploration image showed lesion with areas of hemorrhage within median nerve.

     
    Area of Interest: Neuroradiology peripheral nerve; Imaging Technique: PACS; Procedure: Surgery; Special Focus: Arteriovenous malformations;
     
     
  • Figure 8
    Histopathology (H&E, 10X), image

    Histopathology (H&E, 10X), image of the intraneural lesion of median nerve revealed dilated ectatic and intercommunicating vascular channels.

     
    Area of Interest: Neuroradiology peripheral nerve; Imaging Technique: PACS; Procedure: Biopsy; Special Focus: Arteriovenous malformations;
     
     
  • Figure 9
    Histopathology (H&E 40X) image of lesion

    H$E 40X image of intraneural lesion shows cavernous spaces lined by single layer of endothelial cells.

     
    Area of Interest: Neuroradiology peripheral nerve; Imaging Technique: PACS; Procedure: Biopsy; Special Focus: Arteriovenous malformations;
     
     
  • Figure 10
    40X image of Verhoeff-van Gieson stain for elastic fibres

    Histopathology (40X) image of the lesion is negative for Verhoeff-van Gieson stain for elastic fibres.

     
    Area of Interest: Neuroradiology peripheral nerve; Imaging Technique: PACS; Procedure: Biopsy; Special Focus: Arteriovenous malformations;
     
     
Plain radiograph of right wrist AP view shows no obvious abnormality. No soft tissue calcification/phlebolith. .
 
Plain radiograph of right wrist lateral view shows no obvious abnormality. No soft tissue calcification/phlebolith. .
 
Axial T1W image shows iso to high signal intensity lesion in median nerve at carpal tunnel
 
Coronal T1W image shows iso to high signal intensity lesion in median nerve at carpal tunnel region.
 
Axial T2W image shows high signal intensity lesion in median nerve in carpal tunnel region.
 
Axial STIR image shows high signal intensity lesion within median nerve at carpal tunnel.
 
Axial gradient echo(GRE) image shows blooming within lesion suggestive of intralesional hemorrhage.
 
Coronal gradient echo(GRE) image shows blooming within lesion suggestive of intralesional hemorrhage.
 
Coronal contrast enhanced Fat Sat image of wrist demonstrated significant heterogenous enhancement of the intraneural lesion of median nerve at carpal tunnel region.
 
Axial contrast enhanced Fat Sat image of wrist demonstrated significant heterogenous enhancement of the intraneural lesion of median nerve at carpal tunnel region.
 
Sagittal contrast enhanced Fat Sat image of wrist demonstrated significant heterogenous enhancement of the intraneural lesion of median nerve at carpal tunnel region
 
Intraoperative image showed bluish lesion within median nerve.
 
Intraoperative surgical exploration image showed lesion with areas of hemorrhage within median nerve.
 
Histopathology (H&E, 10X), image of the intraneural lesion of median nerve revealed dilated ectatic and intercommunicating vascular channels.
 
H$E 40X image of intraneural lesion shows cavernous spaces lined by single layer of endothelial cells.
 
Histopathology (40X) image of the lesion is negative for Verhoeff-van Gieson stain for elastic fibres.
 
 
 
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