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JAMA Clinical Challenge

A Right Wrist Lump

Image of low-flow multiple-channel lesion with persisting delayed contrast enhancement at the rightwrist on selective phlebography (delayed acquisition time)

Paola De Rango, MD, PhD
Valentino Pagliuca, MD
A 42-year-old male gardener presents with a 5-cm wrist mass causing functional limitation and swelling of the right hand. The mass has been present since the patient was 12 years old and has progressively enlarged. History is negative for any disease or trauma. At age 26 years the patient underwent orthopedic surgical exploration, but no specific diagnosis was confirmed. The mass is pale, nontender, cold, nonpulsatile, and soft to palpation. The remainder of a general physical examination is unremarkable. Magnetic resonance imaging was not explanatory. Color duplex ultrasonography of the mass shows a cystic appearance with no arterialized flow surrounding the cephalic vein. Angiography reveals persisting contrast enhancement with delayed x-ray fluoroscopy acquisition time at the right wrist level (Figure).

See the full article for an explanation and discussion.

Author Affiliations: Drs De Rango (plderango@gmail.com) and Pagliuca are affiliated with the Unit of Vascular and Endovascular Surgery, Hospital S. M. Misericordia, Perugia, Italy (Dr De Rango); and Poliambulatorio Euromedica, Belluno, Italy (Dr Pagliuca).