Reason: L hand swelling and pain, r/o abscess History: see above. Lobulated and septated collection of near-fluid to fluid signal intensity within the soft tissue surrounding the metacarpophalangeal joint of the index finger. Overall, the collection is approximately 5 cm in longitudinal dimension extending from the neck of the second metacarpal to the level of the mid diaphysis of the proximal phalanx of the index finger. Proximally, the collection extends along the radial aspect of the first dorsal interosseous muscle and extends volar to the first lumbrical muscle, but remains distal to the thenar musculature. Fluid also extends into the web space between the bases of the proximal phalanges of the index and middle fingers. The collection does not appear to involve the flexor tendon apparatus, and there is only minimal fluid within the flexor tendon sheath of the index finger. The collection abuts the extensor tendon, joint capsule and perhaps the adjacent bone, but we see no joint effusion or evidence of osteomyelitis. Generalized subcutaneous edema involves the hand and fingers, particularly dorsally. There is also nonspecific edema within the thenar musculature of the hand. Mild degenerative arthritic changes affect the wrist.
Lobulated collection of fluid signal intensity within the soft tissue surrounding the second metacarpophalangeal joint is compatible with an abscess, with additional soft tissue inflammation as described above. We see no evidence of osteomyelitis.