ARRS 2022 Abstracts

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E1822. Don’t Let These Slip Through Your Fingers: Image-Guided Intervention of Fingers, Metacarpals, and Metatarsals
Authors
  1. Mauricio Ricardo Silva Filho; Institute of Radiology, Hospital das Clínicas, Faculty of Medicine, University of Sao Paulo, Sao Paulo
  2. Ozeas Alves De Noronha Junior; Institute of Radiology, Hospital das Clínicas, Faculty of Medicine, University of Sao Paulo, Sao Paulo
  3. Diogo Leao Edelmuth; Institute of Radiology, Hospital das Clínicas, Faculty of Medicine, University of Sao Paulo, Sao Paulo
  4. Paulo Victor Partezani Helito; Institute of Radiology, Hospital das Clínicas, Faculty of Medicine, University of Sao Paulo, Sao Paulo
  5. Marcelo Bordalo-Rodrigues; Institute of Radiology, Hospital das Clínicas, Faculty of Medicine, University of Sao Paulo, Sao Paulo
Background
Radiological-guided intervention is paramount in the management of musculoskeletal pathologies. Image-guided intervention of fingers is challenging because there are few relevant recent publications and no clear consensus regarding all its aspects.

Educational Goals / Teaching Points
The goal of this exhibit is to review image-guided intervention techniques of fingers, metacarpals, and metatarsals under CT, ultrasonography (US), and fluoroscopic guidance.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit presents a series of patients who underwent image-guided interventions of fingers. Noteworthy cases include the following. A 33-year-old man with pericarpal soft-tissue calcifications with edema and erosion of the fourth metacarpal; CT-guided biopsy confirmed tumoral calcinosis. A 10-year-old girl with an expansile lesion of the third metatarsal; CT-guided biopsy confirmed a chondromyxoid fibroma. A 45-year-old woman with a cutaneous lesion and an irregular lytic lesion on the distal metaphysis of the fifth metatarsal; previous biopsy was inconclusive. A US and fluoroscopy-guided biopsy favored an epithelioid mesenchymal neoplasm, later confirmed as a pseudomyogenic hemangioendothelioma after the lesion resection. A 57-year-old woman with rheumatoid arthritis and articular pain on fingers; previous nonguided injection was unsuccessful. A fluoroscopy-guided infiltration achieved optimal clinical response. A 70-year-old man with a mass around the third finger; a US-guided biopsy confirmed a tenosynovial giant cell tumor. A 48-year-old woman presented with an expansile osteolytic lesion with thin sclerotic margins on the third proximal phalanx; CT-guided biopsy reported a giant cell tumour of the bone. The patient was treated with amputation of the third ray. Anatomopathological report confirmed an aneurysmal bone cyst. In this specific case, patient care was minimally affected as treatment would be similar for both pathologies. Image-guided interventions of fingers are essential and effective in medical practice. As management of finger lesions may depend on a pre-operative definitive histologic diagnosis, percutaneous sampling may be favored due to minimal invasion, low cost, and low complication and hospitalization rates. Also, in this exhibit, image-guided joint injections were more efficient than blind injection for patients with rheumatoid arthritis. Nonetheless, adverse events may include bleedings, hematomas, and infections. Nonrepresentative or technically poor biopsies may similarly compromise the diagnosis and incur inappropriate patient care. Adjuvant techniques are relevant as they improve patient comfort and imply higher success rates; in this exhibit, peripheral regional blocks proved to reduce pain and allowed for better sampling in comparison with local anesthesia.

Conclusion
This exhibit expects to provide a better understanding of image-guided interventions of fingers and a future reference for radiologists, hopefully improving patient best care.