E2640. Palm Reading: A Radiographic Approach to Cystic Lesions in the Hand
  1. Michael Robinson; Atrium Health Wake Forest Baptist
  2. Scott Wuertzer; Atrium Health Wake Forest Baptist
Radiographs are frequently performed as the initial study in the evaluation of hand pain. Cystic osseous lesions may be incidental to the clinical indication but may also represent the source of pain. These lesions may be benign or malignant and often require different treatments. Radiologists should be familiar with the different types of cystic osseous lesions. Following a systematic approach, a narrow differential diagnosis can be generated to appropriately guide management.

Educational Goals / Teaching Points
Review cystic osseous lesions that are frequently encountered in the hand on radiographs. Present an approach to these lesions based on the history of the patient, the location of the lesion, and the appearance of the lesion. Using this approach, review multiple case-based examples that start with plain radiography.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Cystic osseous lesions can be characterized based on the following: location of the lesion, margins of the lesion, and matrix of the lesion. The clinical history and number of lesions (solitary or multiple) can help narrow the differential diagnosis. Location of the lesion should include the type of bone (metacarpal or phalanx), position within the long axis (base, shaft, or head), position within the short axis (central or eccentric), and relationship to the joint. Margin of the lesion should focus on the zone of transition (wide or narrow) and amount of sclerosis. The appearance of the cystic lesion should include the type of matrix (purely lytic, chondroid, or fibrous). The cases will include gout, rheumatoid arthritis, osteomyelitis, enchondroma, sarcoidosis, giant cell tumor, fibrous dysplasia, glomus tumor, epidermoid cyst, hyperparathyroidism, osteoarthritis, and erosive osteoarthritis.

A broad spectrum of pathology can produce cystic lesions in the hand. By following a systematic approach to these lesions, the radiologist can narrow the differential diagnosis, if not reach the precise diagnosis, and ultimately guide the appropriate patient management.