Abstract
Fibrolipomatous hamartoma of the median nerve is an uncommon benign tumour of the childhood, which usually manifests in adolescents or adulthood with signs of compressive neuropathy at wrist. Symptomatic tumour is unusual in children below 5 years age and can be underdiagnosed. Magnetic resonance imaging provides pathognomonic features for the diagnosis, obviating the need for biopsy. Although standard ultrasonography is frequently the first-line imaging approach in the evaluation of soft-tissue masses, sonographic findings of this lesion are less frequently reported and have to be kept in mind by radiologist. We report the unusual case of carpal tunnel syndrome secondary to fibrolipomatous hamartoma of the median nerve in a 4-year-old child successfully treated with surgical carpal tunnel release.
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References
Okechi H, Dimostheni A, Kerscher SR, Gugel I, Bevot A, Schaefer JF et al (2018) Fibrolipomatous hamartomas of the median nerve in infancy and early childhood-imaging hallmarks, symptomatology, and treatment. Eur J Pediatr 177:567–573
Ranjan R, Kumar R, Jeyaraman M, Kumar S (2021) Fibrolipomatous hamartoma (FLH) of median nerve: a rare case report and review. Indian J Orthop 55:267–272
Whittle C, Schonstedt V, Schiappacasse G (2014) Fibrolipomatous hamartoma and its ultrasound diagnosis: case series and review of the literature. Ultrasound Q 30:282–286
Tomà P, Esposito F, Granata C, Paolantonio G, Terranova MC, Lo Re G et al (2019) Up-to-date imaging review of paediatric soft tissue vascular masses, focusing on sonography. Radiol Med 124:935–945
Hsu PC, Chang KV, Wu WT, Wang JC, Özçakar L (2021) Effects of ultrasound-guided peritendinous and intrabursal corticosteroid injections on shoulder tendon elasticity: a post hoc analysis of a randomized controlled trial. Arch Phys Med Rehabil 102:905–913
Lin CY, Chou CC, Chen LR, Wu WT, Hsu PC, Yang TH et al (2022) Quantitative analysis of dynamic subacromial ultrasonography: reliability and influencing factors. Front Bioeng Biotechnol 10:830508
Senger JL, Classen D, Bruce G, Kanthan R (2014) Fibrolipomatous hamartoma of the median nerve: a cause of acute bilateral carpal tunnel syndrome in a three-year-old child: a case report and comprehensive literature review. Plast Surg (Oakv) 22:201–206
Toms AP, Anastakis D, Bleakney RR, Marshall TJ (2006) Lipofibromatous hamartoma of the upper extremity: a review of the radiologic findings for 15 patients. AJR Am J Roentgenol 186:805–811
Gallone G, Di Gennaro GL, Farr S (2020) Peripheral nerve compression syndromes in children. J Hand Surg Am 45:857–863
Rüsch CT, Knirsch U, Weber DM, Rohrbach M, Eichenberger A, Lütschg J, et al. Etiology of carpal tunnel syndrome in a large cohort of children. Children (Basel). 2021;8.
Tahiri Y, Xu L, Kanevsky J, Luc M (2013) Lipofibromatous hamartoma of the median nerve: a comprehensive review and systematic approach to evaluation, diagnosis, and treatment. J Hand Surg Am 38:2055–2067
Biazzo A, González Del Pino J (2013) Paralysis of the median nerve due to a lipofibrohamartoma in the carpal tunnel. Rev Esp Cir Ortop Traumatol. 57:286–95
Hankins CL (2012) Carpal tunnel syndrome caused by a fibrolipomatous hamartoma of the median nerve treated by endoscopic release of the carpal tunnel. J Plast Surg Hand Surg 46:124–127
Meyer BU, Röricht S, Schmitt R (1998) Bilateral fibrolipomatous hamartoma of the median nerve with macrocheiria and late-onset nerve entrapment syndrome. Muscle Nerve 21:656–658
Agrawal R, Garg C, Agarwal A, Kumar P (2016) Lipofibromatous hamartoma of the digital branches of the median nerve presenting as carpal tunnel syndrome: a rare case report with review of the literature. Indian J Pathol Microbiol 59:96–98
Kumari A, Singh S, Garg A, Prakash A, Sural S (2019) Tingling hand: magnetic resonance imaging of median nerve pathologies within the carpal tunnel. Pol J Radiol 84:e484–e490
Ridolfi M, Caruso P, Buoite Stella A, Manganotti P (2020) Very high-resolution ultrasound of the distal median nerve. Clin Neurophysiol 131:1267–1271
Arora R, Arora AJ (2014) Imaging features on sonography and MRI in a case of lipofibromatous hamartoma of the median nerve. Quant Imaging Med Surg 4:207–209
Velicki K, Goldfarb CA, Roberts S, Wall LB (2021) Outcomes of Pediatric and Adolescent Carpal Tunnel Release. J Hand Surg Am 46:178–186
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Guglielmo Paolantonio, Marco Cirillo and Francesca Grussu. The first draft of the manuscript was written by Guglielmo Paolantonio and Marco Cirillo and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Paolantonio, G., Cirillo, M., Grussu, F. et al. Fibrolipomatous hamartoma of the median nerve in a child with carpal tunnel syndrome: imaging findings and literature review. J Ultrasound 26, 913–918 (2023). https://doi.org/10.1007/s40477-022-00741-9
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DOI: https://doi.org/10.1007/s40477-022-00741-9