Rice-Body Formation in Atypical Mycobacterial Tenosynovitis and Bursitis: Findings on Sonography and MR Imaging
C. L. F. Chau1,
J. F. Griffith2,
P. T. Chan3,
T. H. Lui,
K. S. Yu3 and
W. K. Ngai3
1 Department of Radiology, Ground floor, North District Hospital, New
Territories East Cluster, Fanling, New Territories, Hong Kong.
2 Department of Diagnostic Radiology and Organ Imaging, Ground floor, Prince of
Wales Hospital, New Territories East Cluster, Shatin, New Territories, Hong
Kong.
3 Department of Orthopaedics and Traumatology, First floor, North District
Hospital, Fanling, New Territories, Hong Kong.
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Fig. 1A. —69-year-old man with 1-year history of swelling in left
wrist. Axial fast spin-echo T1-weighted MR image (TR/effective TE, 860/10.6;
echo-train length, 3) of wrist reveals markedly distended radial (single
asterisk), intermediate (double asterisks), and ulnar
(triple asterisks) bursae. Flexor tendons are marginally thickened.
Rice bodies are isointense relative to bursal fluid and muscle; tendons cannot
be differentiated from bursal fluid. (Intermediate bursa is normal variation,
providing communication between radial and ulnar bursa.)
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Fig. 1B. —69-year-old man with 1-year history of swelling in left
wrist. Axial fast spin-echo T2-weighted MR image (5220/101; echo-train length,
16) reveals multiple, slightly hyperintense rice bodies (short
arrows) in distended bursae. Bursal walls (long arrows) are
moderately and diffusely thickened. Little or no edema of surrounding soft
tissue is visible. Extensor tendons are normal.
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Fig. 2A. —71-year-old woman with 15-month history of swelling and
symptoms of carpal tunnel syndrome in right wrist. Clinical photograph of
wrist shows soft-tissue swelling distal (short arrow) and proximal
(long arrow) relative to flexor retinaculum (arrowhead).
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Fig. 2B. —71-year-old woman with 15-month history of swelling and
symptoms of carpal tunnel syndrome in right wrist. Longitudinal sonogram of
ulnar bursa reveals multiple large well-defined isoechoic rice bodies within
large bursal effusion. Bursal wall (arrows) is slightly
thickened.
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Fig. 2C. —71-year-old woman with 15-month history of swelling and
symptoms of carpal tunnel syndrome in right wrist. Sagittal fast spin-echo
T2-weighted fat-saturated MR image (TR/effective TE, 3840/105; echo-train
length, 12) reveals multiple rice bodies (arrows) in distended
radioulnar bursa and flexor tendon sheath proximal and distal relative to
flexor retinaculum. R = radius, C = capitate bone.
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Fig. 2D. —71-year-old woman with 15-month history of swelling and
symptoms of carpal tunnel syndrome in right wrist. Axial fast spin-echo
T2-weighted MR image (4000/105; echo-train length, 12) obtained distal
relative to carpal tunnel shows multiple slightly hyperintense rice bodies
(arrows) in distended bursae. Bursal wall is slightly thickened. Mild
edema is evident in adjacent muscle and soft tissues.
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Fig. 2E. —71-year-old woman with 15-month history of swelling and
symptoms of carpal tunnel syndrome in right wrist. Photograph acquired during
surgery reveals multiple white smoothly marginated rice bodies
(arrow) in dissected radioulnar bursae.
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Fig. 3A. —50-year-old man with left wrist swelling for 1 year.
Longitudinal (A) and transverse (B) sonograms of wrist show
low-level internal echoes (arrows) without acoustic shadowing in deep
portion of ulnar bursa (U, B) and surrounding flexor digitorum
superficialis and profundus (P) tendons. Some mass effect is evident. Discrete
rice bodies cannot be seen. R = radius.
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Fig. 3B. —50-year-old man with left wrist swelling for 1 year.
Longitudinal (A) and transverse (B) sonograms of wrist show
low-level internal echoes (arrows) without acoustic shadowing in deep
portion of ulnar bursa (U, B) and surrounding flexor digitorum
superficialis and profundus (P) tendons. Some mass effect is evident. Discrete
rice bodies cannot be seen. R = radius.
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Fig. 3C. —50-year-old man with left wrist swelling for 1 year. Axial
(C) and coronal (D) fast spin-echo MR images (TR/effective TE,
3800/105; echo-train length, 12) reveals multiple tiny hypointense rice bodies
(arrows) that almost completely fill radial and ulnar bursae. These
rice bodies are much smaller than those seen in Figures
1B and
2D. Bursal wall is slightly
thickened. P = flexor digitorium profundus tendons, R = radius, U = ulna.
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Fig. 3D. —50-year-old man with left wrist swelling for 1 year. Axial
(C) and coronal (D) fast spin-echo MR images (TR/effective TE,
3800/105; echo-train length, 12) reveals multiple tiny hypointense rice bodies
(arrows) that almost completely fill radial and ulnar bursae. These
rice bodies are much smaller than those seen in Figures
1B and
2D. Bursal wall is slightly
thickened. P = flexor digitorium profundus tendons, R = radius, U = ulna.
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Copyright © 2003 by the American Roentgen Ray Society.
