Hand mass There is a mass within the palm of the hand situated between the flexor tendons of the middle and ring fingers, volar to the intraosseous muscles. It is approximately 1.5 cm in transverse dimension and 2.5 cm in longitudinal dimension, subjectively appearing slightly larger on the current exam when compared to the prior. The mass is isointense to skeletal muscle on T1 sequences and heterogeneously hyperintense to skeletal muscle on fat suppressed T2 sequences while demonstrating peripheral, slightly irregular enhancement following administration of intravenous gadolinium. A tail of edema and enhancement extends proximally from the mass towards the wrist terminating at the level of the distal carpal row deep within the carpal tunnel. Similar edema and enhancement extends distally through the lumbrical to the level of the metacarpal head. The mass splays the flexor tendons of the third and fourth fingers.We see no additional masses. The remaining soft tissue and bones otherwise appear normal.
Mass within the palm of the hand as described above. Although this may represent a ganglion cyst, the slightly irregular nature of the peripheral enhancement, the signal heterogeneity on T2W sequences, and the adjacent tail-like enhancement/edema are somewhat atypical features for a ganglion. Other entities such as a nerve sheath tumor should also be considered. Note that on the basis of these images, malignancy cannot be excluded.