0:01

A few joyous, not so mentally challenging cases

0:05

where the anatomy isn't as critical as a little bit

0:09

of knowledge of MR.

0:11

And pathology. Uh, this is case 80,

0:16

uh, 39-year-old

0:18

with a vola mass in the fifth finger getting larger

0:21

over the last two years.

0:24

So a very limited differential diagnosis here.

0:27

Let's put up something in the long axis projection.

0:31

And, uh, you know, I used to think of this lesion

0:34

as something that really occurred almost exclusively

0:37

on the Palmer aspect of the hand.

0:39

'cause you think about touching something

0:41

and getting stuck, you usually don't touch

0:43

with the back of your hand.

0:45

But I've seen a, a rash

0:47

of epidermoids in the dorsal aspect of the fingers.

0:50

So how do you, how do you approach a case like this?

0:53

Um, well, it's a mass and,

0:56

and then the next thing I do, I'm in a very small area,

1:00

so I, I lean on the anatomy that I know,

1:02

and I know the neurovascular bundles are,

1:06

are off to the side.

1:07

So if I have eccentricity, that helps me,

1:10

that pushes me in the direction of something like a,

1:13

a cystic schwannoma,

1:14

which will sometimes have a little granularity in it.

1:17

And that's honestly what I thought this was going to be.

1:21

Um, it turned out to be an epidermoid or a rather large one,

1:25

and there, there weren't other, a lot

1:27

of other considerations.

1:28

You know, when you have this smooth white lesion on a T two,

1:31

a mix, Soma would be one and a ganglion would be the other.

1:35

And you can get outta jail pretty easily

1:37

by simply giving contrast.

1:38

Be, because I think most of you know,

1:40

epidermoids don't enhance ganglion pseudocyst do not enhance

1:45

yet mix omas, which which can be variable in their behavior.

1:50

Do, do enhance.

1:52

And schwannomas certainly most of the time do enhance.

1:56

Um, I don't think we gave contrast on this one,

1:58

but we were surprised when we got back the

2:00

diagnosis of epidermoid.

2:02

We did list it, but it wasn't our first choice.