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Tuberculous Infection of the Wrist: MRI Features

Chao-Yu Hsu1,2, Hsueh-Chieh Lu1 and Tiffany Ting-Fang Shih1,2

1 Department of Medical Imaging, National Taiwan University Hospital, 7, Chung-Shan S. Rd. Taipei, Taiwan.
2 Department of Radiology, National Taiwan University, School of Medicine, Taipei, Taiwan.



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  		Fig. 1A. —Tuberculous infection of right wrist in 64-year-old woman (case 7) with 8-month history of right wrist swelling, soft-tissue mass, and carpal tunnel syndrome. Radiograph in anteroposterior projection shows malalignment of wrist with erosion of distal radius, distal ulna, and carpal bones (arrows).

 


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  		Fig. 1D. —Tuberculous infection of right wrist in 64-year-old woman (case 7) with 8-month history of right wrist swelling, soft-tissue mass, and carpal tunnel syndrome. Axial fast spin-echo T2-weighted MR image (3,500/96) shows synovial fluid collection in flexor tendon sheath and heterogeneous intermediate to low signal intensity of thickened tenosynovium. Crescent-shaped fluid collection (arrow) is identified with displacement of flexor tendons. Small low-signal foci are in synovial fluid collection.

 


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  		Fig. 1E. —Tuberculous infection of right wrist in 64-year-old woman (case 7) with 8-month history of right wrist swelling, soft-tissue mass, and carpal tunnel syndrome. Axial gadolinium-enhanced spin-echo T1-weighted MR image (475/14) shows enhancement of thickened tenosynovium around intertendinous fluid collection (arrow) and flexor tendon (arrowhead).

 


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  		Fig. 1F. —Tuberculous infection of right wrist in 64-year-old woman (case 7) with 8-month history of right wrist swelling, soft-tissue mass, and carpal tunnel syndrome. Axial fast spin-echo T2-weighted MR image (3,500/96) shows synovial lesions involving flexor tendons, bone, and joint. They form lobulated mass (black arrows) seen with predominantly heterogeneous foci of low signal intensity. Flexor retinaculum (arrowheads) of carpal tunnel has palmar bulging, and median nerve (white arrow) is encased. Extensor tendons are displaced away from bone.

 


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  		Fig. 1G. —Tuberculous infection of right wrist in 64-year-old woman (case 7) with 8-month history of right wrist swelling, soft-tissue mass, and carpal tunnel syndrome. Axial gadolinium-enhanced spin-echo T1-weighted MR image (475/14) shows irregular and heterogeneous enhancement of lobulated mass (arrows).

 


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  		Fig. 2A. —Tuberculous infection of right wrist in 90-year-old man (case 6) with 12-month history of right wrist swelling and soft-tissue mass. Axial fast spin-echo T1-weighted MR image (TR/TE, 650/15) shows synovial lesions involving extensor tendons, bone, and joint (arrows). Synovial fluid collections (arrowheads) are seen as intermediate to low signal intensity in distended extensor tendon sheaths.

 


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  		Fig. 2B. —Tuberculous infection of right wrist in 90-year-old man (case 6) with 12-month history of right wrist swelling and soft-tissue mass. Axial fast spin-echo T2-weighted MR image (3,300/88) shows osteoarticular lesions (arrows) seen as heterogeneous high signal intensity with multiple foci of low signal intensity. Synovial fluid collections (arrowheads) are seen as high signal intensity in distended extensor tendon sheaths with heterogeneous intermediate to low signal intensity of thickened tenosynovium.

 


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  		Fig. 2C. —Tuberculous infection of right wrist in 90-year-old man (case 6) with 12-month history of right wrist swelling and soft-tissue mass. Axial gadolinium-enhanced spin-echo T1-weighted MR image (650/16) shows enhancement of osteoarticular lesions (arrows) and thickened tenosynovium of extensor tendons (arrowheads).

 


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  		Fig. 3A. —Tuberculous infection of right wrist in 58-year-old man (case 3) with 6-month history of painful right wrist swelling and carpal tunnel syndrome. Sagittal fast spin-echo T2-weighted MR image (3,950/86) shows tumorlike synovial proliferation involving flexor tendons (arrows).

 


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  		Fig. 3B. —Tuberculous infection of right wrist in 58-year-old man (case 3) with 6-month history of painful right wrist swelling and carpal tunnel syndrome. Axial fast spin-echo T2-weighted MR images (3,280/88) show synovial lesions seen as heterogeneous intermediate signal intensity with multiple foci of low signal intensity in distended flexor tendon sheaths (black arrows) and carpal tunnel. Flexor retinaculum (arrowheads, C) of carpal tunnel has palmar bulging, and median nerve (white arrow, C) is encased.

 


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  		Fig. 3C. —Tuberculous infection of right wrist in 58-year-old man (case 3) with 6-month history of painful right wrist swelling and carpal tunnel syndrome. Axial fast spin-echo T2-weighted MR images (3,280/88) show synovial lesions seen as heterogeneous intermediate signal intensity with multiple foci of low signal intensity in distended flexor tendon sheaths (black arrows) and carpal tunnel. Flexor retinaculum (arrowheads, C) of carpal tunnel has palmar bulging, and median nerve (white arrow, C) is encased.

 


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  		Fig. 1B. —Tuberculous infection of right wrist in 64-year-old woman (case 7) with 8-month history of right wrist swelling, soft-tissue mass, and carpal tunnel syndrome. Coronal gradient-echo T2*-weighted MR image (TR/TE, 542/24; flip angle, 30°) shows tumorlike synovial proliferation (arrows), osteomyelitis, and bone erosion (arrowheads).

 


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  		Fig. 1C. —Tuberculous infection of right wrist in 64-year-old woman (case 7) with 8-month history of right wrist swelling, soft-tissue mass, and carpal tunnel syndrome. Coronal gadolinium-enhanced fat-saturated spin-echo T1-weighted MR image (650/16) shows enhancement of thickened synovium (arrows).

 

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