e-CASES: Hypothenar hammer syndrome

檢查結果

@1.1 ultrasound showing hypoechogenicareawith doppler ulnar artery flow restriction 

@8.20 Axial T1, @7.20 Axial T2 FS, @3.23 TWIST early image, @3.34 TWIST late image

MRI and angio MR showing complete occlusion of ulnar artery at level of hamate  bone from thrombosed ulnar artery aneurysm; radial artery contributes to blood arterial supply

診斷

Hypothenar hammer syndrome

討論

DEFINITION

Thrombosed ulnar artery aneurysm of the dominant hand of a manuel worker

CHARACTERISTIC CLINICAL FEATURES AND RADIOLOGIC FINDINGS

Most aneurysms of the hand and wrist involve the ulnar artery which is hammered against the hook of the carpal hamate bone in the hypothenar eminence.

Ultrasound and MRI are actually the most accurate methods for diagnosing and locating ulnar artery aneurysms; arteriography is mandatory to document the professional disease.

@12.1 early film ; @13.1 later film.

Arteriography showing complete occlusion of ulnar artery 

DDx

Other etiology of ischemia of the hand (thoracic outlet syndrome, arteriosclerosis or thromboangiitis obliterans)

參考資料

1. Anderson SE et al. Imaging features of pseudo anevrysms of the hand in children and adults. AJR:180, March 2003
2. Blum AG et al. Pathologic conditions of the hypothenar eminence: Evaluation with multidetector CT and MR Imaging RadioGraphics 2006; 26: 1021-1044
3. Liskutin J, Dorffner R, Resinger M, Silberbauer K, Mostbeck G. Hypothenar hammer syndrome.Eur Radiol. 2000