0:00

This is a 27 year old woman and she had numbness and tingling in the

0:05

second and third digits. She'd had it for a couple of years,

0:09

some associated swelling. She had some grip strength, weakness, so apologies.

0:13

These are not normally aligned.

0:15

I think that she moved in between portions of acquiring these sequences.

0:20

So just going from distal in the hand there,

0:23

moving a little bit more proximal on our T1 and our PD fat set

0:28

sequences.

0:32

And this may be one of those t many cases you've seen it before or you haven't.

0:37

So our last multiple choice question here,

0:41

lipo fibromatosis. Hamartoma, it's a mouthful.

0:45

It most frequently affects which nerve.

0:50

All right. And the correct answer is, of course, the median nerve. Very good.

0:53

So just like our case presentation, um,

0:56

the median nerve lipo fibromatosis, hamartoma.

1:00

So this comes by many names. There's some combination of fibroblasts and,

1:05

um, and adipose tissue proliferation. We thought it's,

1:09

it's really the hypertrophy of the epineurium and it can involve other nerves.

1:14

But by and far, most commonly seen in the median nerve, um,

1:17

patients can also have macole of the digits or of the hand itself.

1:21

So let's go back to our, um, imaging findings here. This is a pretty, um,

1:27

profound example. I think you can really appreciate, uh,

1:30

the fatty hypertrophy of the epineurium.

1:33

Once you get into the kind of distal carpal tunnel. In this case,

1:35

you can see the, the more central nerve elements, um, uh,

1:39

kind of more centrally located within this really fatty hypertrophy. Um,

1:43

and you can see the increased signal and really that fas particular appearance

1:47

of all of those nerve fascicle has, of course, through the median tunnel, uh,

1:51

sorry, through the carpal tunnel involving that median nerve.

1:53

Sometimes this is called the strands of spaghetti appearance. Uh,

1:57

and you can appreciate why.

1:59

You can see how these really look like they're just parallel. Uh,

2:02

you get lots of redundancy or kind of granulation of those,

2:05

of those nerve fibers there as well. So, all right,

2:10

I'll switch back to our presentation here. I think that is it for me.

2:14

I'm more than happy to answer questions if you have any. Um,

2:18

thank you all for participating. Uh,

2:21

I get excited about nerve imaging and happy to share some cases with you guys.

2:25

So thank you. Feel free to email me if anything comes up.