%0 Journal Article
%T Fibrolipomatous hamartoma in the median nerve in the arm - an unusual location but with MR imaging characteristics: a case report
%A Jessica Nilsson
%A Kristina Sandberg
%A Lars B Dahlin
%A Nina Vendel
%A Eva Balslev
%A Lone Larsen
%A Niels Nielsen
%J Journal of Brachial Plexus and Peripheral Nerve Injury
%D 2010
%I Thieme Medical Publishers
%R 10.1186/1749-7221-5-1
%X The two most common nerve tumours in the upper extremity are Schwannoma and neurofibroma [1,2]. More rare is a fibrolipomatous hamartoma, a benign, slow-growing mass, which is usually located in the median nerve distally in the forearm [3-7] and in its digital branches [1,4,5]. With MR imaging it is not always possible to make a diagnosis of a nerve tumour [2], but the MR imaging characteristics of fibrolipomatous hamartoma are considered to be pathognomonic [3]. In coronal plane, the nerve tumour is characterised by serpiginous structures [4,6] (thickened nerve fascicles), which are surrounded by fat (high signal intensity on T1-weighted images, low signal intensity on fat-suppressed T2-weighted images) [3]. In most of the cases the fat is distributed between the nerve fascicles making the nerve tumour looking like a coaxial cable in the axial plane [3-5,8,9]. Even if the nerve tumour has a characteristic feature on MRI the suspicion of a nerve tumour is not always obvious for the clinician. Here we report a case with obscure clinical symptoms and signs of isolated median nerve dysfunction, where the MR imaging showed the characteristic features of a fibrolipomatous hamartoma in the arm and the diagnosis was verified by an incisional biopsy.A 57 year right-handed secretary was referred to our hospital July 2008. She described symptoms since November 2002 with paresthesia in the right index, long and ring (half of it) fingers. Furthermore, she told about fibrillations in the interphalangeal joint of the right thumb and the index finger, loss of FPL and FDP function to the index finger followed by atrophy of the thenar muscles a year later. She was operated with carpal tunnel release at another hospital April 2007 due to a suspicion of a carpal tunnel syndrome, but no neurography or electromyography (EMG) was performed. In addition, she was operated with division of the A1 pulley on the right thumb due to a suspicion of a right-sided trigger thumb, but with no improv
%U http://www.jbppni.com/content/5/1/1