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    • #19797
      Xue Heng

      Hi, Steve. Here is a case that confused me.
      The patient was a 25-year-old lady, with bilateral dorsal wrist swelling for more than 10 years.
      She had no tenderness or other discomfort.
      Thickened echogenic tissue was observed around dorsal wrist tendon, with increased color Doppler signal.
      The wrist jonint and ventral wrist tendon were normal.
      Is the thickened echogenic tissue proliferative synovium?
      But synovitis are often observed as hypoechoic tissue and the patient was asymptomatic.
      I have no idea and turn you for help.
      Thank you very much, Steve.

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    • #19847
      Stephen Bird

      Hi Xue,

      This one is a puzzle and I would be keen to hear the opinion of anyone else lucky enough to see these images.

      The things that come to mind:

      It looks like it is within the extensor digitorum communus tendon sheath (extensor compartment 4).

      It is bilateral,

      It is clinically swollen but not painful.

      what happens inside tendon sheaths in the wrist?

      Synovitis (chronic in this case). It is usually less echogenic than this but may be echogenic on occasions. It is usually vascular like you are showing. It is usually more painful than this patient. It would explain why it is bilateral as this would be part of a systemic rheumatoid condition.
      What about Lipoma Arborescens in this unusual location. It would explain the echogenicity, the chronic nature and the lack of pain???

      PVNS / giant cell tumour. Usually less echogenic

      Synovial haemangiona??? unlikely

      I can’t think of anything else.

      If you get some follow up please keep us informed,

      Great case Xue,


    • #19897
      Xue Heng

      Thank you for analyzing so many possibilities.
      Differential diagnosis is the difficult but we enjoy it.
      It can help us reaching the truth.
      I would follow up the patient and inform you.

    • #19944
      Stephen Bird

      This is a great teaching case if we can get the final answer through follow up.

      I am looking forward to your next post on this subject.

      Have a great week Xue,


    • #30115
      Chunyan Du

      I had a similar case presented with left side dorsal wrist swelling , no pain and the ultrasound appearance
      is similar but no vascularity , pt was also asymptomatic. I was wondering what it could be .

    • #30118
      Stephen Bird

      Hi Chunyan and Xue,

      It would be great to get an MRI of one of these patients to assist us in coming to the correct conclusion.

      It sounds like both of these patients have the same condition,

      If either of you can organise an MRI that would be the next step.


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