Fibrolipomatous Hamartoma of the Median Nerve Misdiagnosed as a Palmar Space Abscess: A Case Report.
Ranjan Kumar Jha Snr, Gaurab Acharya, Arun Kumar Chaurasiya et al.
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Case in brief
A 17-year-old girl had progressive left-hand swelling and paraesthesia over 5 years, followed by pain and reduced grip strength. The mass had been treated as an acute mid-palmar abscess with incision and drainage, without benefit. MRI showed marked median nerve enlargement with axial “coaxial cable” and coronal “spaghetti-like” appearances, supporting fibrolipomatous hamartoma. Biopsy was avoided, and she underwent open carpal tunnel decompression. At 6-month follow-up, symptoms had substantially improved, pain-free grip and pinch strength had returned, and there was no neurological deterioration.
What made this case unusual
The median nerve lesion was mistaken for a palmar space abscess, leading to an ineffective incision and drainage; MRI then showed characteristic nerve patterns that supported diagnosis without biopsy.
Diagnostic / clinical pearl
In a slowly progressive hand mass with median nerve symptoms, consider fibrolipomatous hamartoma. Its characteristic MRI appearance can support a clinicoradiological diagnosis and help avoid potentially injurious biopsy.