ACUTE MEDIAL ELBOW PAIN AND SWELLING IN A YOUNG FEMALE PATIENT MITCHELL TA, MD; AHMED T. RASHAD, MD; NEEL D. GUPTA, MD; VISHNUPRIYA KUCHANA, MD; JEREMY NGUYEN, MD FACR HISTORY 12 year-old female with a 1-year history of discomfort and intermittent swelling along the medial aspect of her right elbow presents with acute medial elbow pain.
Figure 1
Figure 2
Figure 3
Contrast-enhanced axial CT of the elbow
Axial T1 FS +C MRI of the elbow
Sagittal T1 FS + C of the elbow
IMAGING FINDINGS Figure 1. Contrast CT in axial projection demonstrates focal calcification within the mass with adjacent heterogenous contrast enhancement. Figure 2. Axial T1 FS post contrast demonstrates a fusiform mass with heterogenous enhancement posteromedial to the medial epicondyle intimately associated with the ulnar nerve. Figure 3. Sagittal T1 FS post contrast demonstrates a fusiform mass with heterogenous enhancement posteromedial to the medial epicondyle intimately associated with the ulnar nerve. DIFFERENTIAL DIAGNOSIS 1. Intraneural hemangioma with ulnar nerve involvement
DISCUSSION Intraneural hemangiomas are benign, rare lesions of mesodermal origin formed by proliferation of vascular structures that may arise within a peripheral nerve, within the nerve sleeve, or around the nerve. Most commonly involving the median nerve, intraneural hemangiomas may also be found in association with the tibial, ulnar, digital, sciatic, and superficial peroneal nerves 1 . Ulnar nerve involvement is least common with approximately 13 published cases 2 . Intraneural hemangiomas often manifest in childhood as a painful mass that resides along the path of the nerve. Patients with this painful mass often have associated neurologic deficits, paresis, or paresthesia due to mass effect 3 . Ultrasound and MRI imaging may help form a diagnosis. Nerve conduction studies are additionally helpful in patients with neurological symptoms. Diagnosis is confirmed with histopathology, and treatment is surgical resection. Of note, incomplete resection may lead to recurrence. Intraneural hemangiomas often appear hyperintense on fat-suppressed T2-weighted sequences and enhance with administration of gadolinium. Intraneural hemangiomas follow the path of the involved nerve. MRI may also aid in the localization and size assessment of the mass while visualizing the relationship between the mass and surrounding tissue 4 .
2. Schwannoma 3. Glomus tumor 4. Angioleiomyoma 5. Lipofibromatous hamartoma 6. Hematoma FINAL DIAGNOSIS Ulnar nerve hemangioma
10 J LA MED SOC | VOL 175 | FALL 2023
Made with FlippingBook Digital Publishing Software