It’s been a while….I was enjoying a fabulous vacation…and now that I’m back, I’m already confused.
In my absence, there have been MANY people who have newly joined this group….Welcome.
I believe that is in large part due to the active LinkedIN OCAD page….with weekly or bi-weekly quiz cases, recently provided by my wonderful collaborator Renata Vidal Leão Sanford (if you haven’t, you should check out the page).
This patient initially had bilateral US for suspected carpal tunnel syndrome 1 month ago (the median nerve is thickened in the CT inlet bilaterally).She has a palpable lump in Guyon’s canal….I don’t know how long or if there is pain / paresthesias, so we scanned that with US too
I recommended MRI without and with contrast
The bright PDFS macrolobulated mass correlates with the mass we see on US, arising from the periphery of the Ulnar nerve (more clearly demonstrated by US…..we see it in sequential axial MR images, take my word for it)
So this is the question.
No enhancement….which surprised me.
I remember being told that malignant nerve sheath tumors may not enhance as much as benign PNST…..but there is No enhancement….I don’t want this to be a malignant tumor.
Could this be a complex nerve sheath ganglion?
Anything else?
What do you think?
Thank you.
Hilary
