Hyperechoic lesion superficial to the triquetrum bone.

[Xue Heng]

Hi, Steve.
This is a 35-year-ole male patient (Yes, it’s me), with slight medial wrist pain for 2-3 months.
He performs US for about 30 hours a week, and plays table tennis about 2 hours a week.
He had no history of trauma or overuse.
A hyperechoic lesion was observed superficial to the triquetrum bone, without other abnormalities.
What might be the possible diagnosis? CPPD?
Thank you, Steve.

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[Stephen Bird]

This looks like a crystal deposition disease in the extrinsic radiotriquetral ligament,

There looks like a subtle echogenic blush superficial to the bone, within the radiotriquetral ligament.

There is no hyaline cartilage on the dorsal aspect of the triquetrum as it is not an articulating surface.

It is however an enthesis for the radiotriquetral ligament and also the flexor retinaculum.

I think there are 4 options.

It could be gout,

It could be hydroxyapatite

It could be CPPD

It could be dystrophic calcification / scar tissue from an injury to the radiotriquetral ligament which would usually occur following a FOOSH (fell on outstretched hand) injury.

If you do a perfect lateral radiograph you will see a density if it is CPPD or hydroxyapatite.

It will be invisible on the xray if it is gout and if it is post injury scar tissue it will be invisible unless it has a significant dystrophic calcification component.

I think these are your options.

Steve

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