What’s the Diagnosis – Case 168
1
What’s the Diagnosis – Case 168
2
What’s the Diagnosis – Case 168
3
What’s the Diagnosis – Case 168
4
What’s the Diagnosis – Case 168
5
What’s the Diagnosis – Case 168
6
What’s the Diagnosis – Case 168
7
What’s the Diagnosis – Case 168
8
What’s the Diagnosis – Case 168
9
What’s the Diagnosis – Case 168
10
What’s the Diagnosis – Case 168
11
What’s the Diagnosis – Case 168
12
What’s the Diagnosis – Case 168
13
What’s the Diagnosis – Case 168
14
What’s the Diagnosis – Case 168
15
What’s the Diagnosis – Case 168
16
What’s the Diagnosis – Case 168
17
What’s the Diagnosis – Case 168
18
What’s the Diagnosis – Case 168
19
What’s the Diagnosis – Case 168
20
What’s the Diagnosis – Case 168
21
What’s the Diagnosis – Case 168
22
What’s the Diagnosis – Case 168
23
What’s the Diagnosis – Case 168
24
What’s the Diagnosis – Case 168
25
What’s the Diagnosis – Case 168
26
What’s the Diagnosis – Case 168
27
What’s the Diagnosis – Case 168
28
What’s the Diagnosis – Case 168
29
What’s the Diagnosis – Case 168
30
What’s the Diagnosis – Case 168
31
Findings The radiographs are not contributory on this case. On the MRI, there is a marked enlargement of the median nerve proximal to the carpal tunnel and within the more proximal aspect of the tunnel. The individual fascicles are markedly enlarged and T2 hyperintense. The markedly enlarged median nerve flattens out at the distal aspect of the carpal tunnel by the level of the hook of the hamate. There is a prominent bowing of the flexor retinaculum.
What’s the Diagnosis – Case 168
32
What’s the Diagnosis – Case 168
33
What’s the Diagnosis – Case 168
34
What’s the Diagnosis – Case 168
35
What’s the Diagnosis – Case 168
36
What’s the Diagnosis – Case 168
37
What’s the Diagnosis – Case 168
38
What’s the Diagnosis – Case 168
39
What’s the Diagnosis – Case 168
40
What’s the Diagnosis – Case 168
41
What’s the Diagnosis – Case 168
42
What’s the Diagnosis – Case 168
43
What’s the Diagnosis – Case 168
44
What’s the Diagnosis – Case 168
45
What’s the Diagnosis – Case 168
46
What’s the Diagnosis – Case 168
47
What’s the Diagnosis – Case 168
48
What’s the Diagnosis – Case 168
49
What’s the Diagnosis – Case 168
50
What’s the Diagnosis – Case 168
51
What’s the Diagnosis – Case 168
52
What’s the Diagnosis – Case 168
53
What’s the Diagnosis – Case 168
54
What’s the Diagnosis – Case 168
55
Diagnosis: Carpal Tunnel Syndrome (CTS) This is a very nice example of an entity we do not seen frequently on MRI as it is so commonly diagnosed clinically and/or with ultrasound. CTS is a compression neuropathy of the median nerve as it traverses the carpal tunnel. The nerve will be enlarged with large and T2 hyperintense fascicles often proximal to the carpal tunnel extending to the proximal aspect of the tunnel at the level of the pisiform. The nerve then becomes compressed further distally at the level of the hook of the hamate. The enlargement of the nerve precipitates a bowing of the flexor retinaculum. Multiple measurements can be utilized on MRI and especially US to help confirm the diagnosis. As in this case, there is a predominance of middle aged woman with this process. CTS may relate to overuse, a mass occupying the carpal tunnel, or a number of other processes.
What’s the Diagnosis – Case 168
56
References MRI criteria for diagnosis and predicting severity of carpal tunnel syndrome. Alex W H Ng, James F Griffith, Cina S L Tong, Eric K C Law, W L Tse, Clara W Y Wong, P C Ho. Observational Study Skeletal Radiol. 2020 Mar;49(3):397405. doi: 10.1007/s00256-019-03291-0. Epub 2019 Aug 9. Carpal tunnel: MR imaging. Part II. Carpal tunnel syndrome. M Mesgarzadeh, C D Schneck, A Bonakdarpour, A Mitra, D Conaway. RSNA Radiology Published Online:Jun 1 1989https://doi.org/10.1148/radiology.171.3.2541464. Carpal tunnel syndrome. Radswiki, T., Knipe, H. Radiopaedia.org. (accessed on 06 Apr 2022) https://doi.org/10.53347/rID-12632.
What’s the Diagnosis – Case 168
57