0:00

So this is a 41 year old patient who has a slowly enlarging

0:05

mass arising from the Palmer aspect of the index

0:10

finger, d i p joint, the mass standard.

0:15

We noticed on the sagittal T one weighted images that this mass is

0:20

intermediate signal intensity.

0:23

On T one is homogeneously intermediate signal

0:27

intensity has a very well defined peripheral margin,

0:33

and very important for this case is in direct continuity

0:38

with the dermis with the skin line on fluid sensitive

0:44

sequences,

0:44

we notice that the mass is predominantly fluid like signal intensity.

0:49

It does have a peripheral green of hyperintensity

0:55

as in a pseudo capsule.

0:57

And what nails the diagnosis is the behavior of post contrast images.

1:02

So we see that this is only peripherally enhancing.

1:06

There are no solid internal components.

1:09

The content of the lesion is intermediate signal intensity.

1:14

Also on the T one post contrast images,

1:17

this is due to the complexity of the fluid.

1:21

So this is not simple fluid signal that we'll see

1:26

homogeneously bright or low signal intensity on T two

1:31

and T one weighted images. This has some complexity, uh,

1:36

and debris, uh, within the content, uh,

1:39

which gives this particular behavior on m r i.

1:44

Um,

1:44

the findings are in keeping with an epidermoid inclusion system.

1:49

Um,

1:50

they are one of the top differential diagnosis for masses in

1:55

the fingers and which should distinguish this entity

2:00

from an atypical gangs, uh,

2:02

which could have some complexity or perhaps a superimposed infection

2:08

on a gang cyst would be a consideration.

2:12

Other considerations, uh,

2:14

here will include also a giant cell tumor of tendon sheath and

2:19

now turn teno synovial giant cell tumor.

2:23

And that would be the prime considerations in the differential diagnosis.

2:28

So what gives away this case is the continuity with the

2:33

dermis. This is an epidermal

2:37

and characteristics of the.