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Capelastegui A, Astigarraga E, Fernandez-Canton G, Saralegui I, Larena JA, Merino A. Masses and pseudomasses of the hand and
wrist: MR finfings in 134 cases. Skeletal Radiol 1999;28:498—507.
PSEUDO-TUMOUR
• Carpal boss
• Accessory muscles
• Granuloma
• Calcifications
HOW TO RULE OUT A PSEUDO-TUMOUR ?
Gout
• Arthropathy ? Calcinosis
• Calcifications ?
• …
DIP Arthrosis
X-RAYS ARE ALWAYS NECESSARY !
?
HOW TO RULE OUT A PSEUDO-TUMOUR ?
• Sonography
Foreign body
• Easy access
• Not expensive
Sc
Sc
DIAGNOSTIC STRATEGY
• 2 nd step: rule out a cyst : 40-60% of all hand
tumours
• Localisation
• Palpation
• Transillumination
• (Sonography)
GANGLION AND SONOGRAPHY
Teefey SA et al. Ganglia of the hand and wrist: a sonographic analysis. AJR Am J Roentgenol 2008;191: 716-720.
DIAGNOSTIC STRATEGY
• This is a tumor
Chondromas 73
• Most are rare or very rare
Schwanomas 44
• Non-cystic tumors Epidermal cysts 41
represented 25% of 134
masses, including 0,2% of Fibromas 23
malignant tumors 1714 tumours operated on
at the Institut de la Main
Capelastegui A, Astigarraga E, Fernandez-Canton G, Saralegui I, Larena JA, Merino A. Masses and pseudomasses of the hand and
wrist: MR finfings in 134 cases. Skeletal Radiol 1999;28:498—507.
CHARACTERIZE A TUMOR MASS
Plain X-rays
Bone or Soft-tissue
calcified tumour tumour
PLAIN X-RAYS
• Tumor characteristics
• Periosteal reaction
• Adjacents soft-tissues
• Growth plate
http://www.radiologyassistant.nl/en
Age Well-defined Ill-defined Sclerotic
EG EG-Ewing osteosarcoma,
0-10 SBC leukemia
Osteosarcoma
Chondroma, osteoma,
Giant CT, chondroma,
bone island, parental
Chondrosarcoma, HPT-
20-40 Brown tumor,
Giant CT osteosarcoma, healed
lesions (NOF, EG, SBC,
Osteoblastoma
ABC,Chondroblastoma)
Metastases, myeloma,
Metastases, Myeloma,
40+ geode
chondrosarcoma (high Metastase, bone island
grade)
• CT scan
Chondrosarcoma
3RD LINE: MRI
• MRI shows components such as cartilage, vascular
tissue, fat, liquid and haemosiderin
Chondroma
Chondroma
SOFT-TISSUE TUMORS
• Ultrasonography +++
• To demonstrate
unsuspected lesions
Osteoid Osteoma
• Screening in malignant
tumors (PET scan more
sensitive and specific)
VASCULAR INVESTIGATION
• Potential invasion of
vessels in malignant
tumors.
IMAGING TECHNIQUES ARE
COMPLEMENTARY
IMAGING TECHNIQUES ARE
COMPLEMENTARY