Soft Tissue Lesions
A variety of soft tissue lesions are detectable on hand radiographs. Chondrocalcinosis refers to the finding of calcification in hyaline and/or fibrocartilage, and may be caused by several different disorders. Extraskeletal chondroma is a rare tumor that
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Soft Tissue Lesions
3.1
Chondrocalcinosis
3.2
Extraskeletal Chondroma
3.3
Joint Contractures
3.4 Metastatic Soft Tissue Calcification 3.5
Soft Tissue Edema
3.6 Vascular Calcification
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3.1
Soft Tissue Lesions
Chondrocalcinosis
Chondrocalcinosis refers to the radiographic finding of calcification in hyaline and/or fibrocartilage. It may be caused by several different disorders, such as calcium pyrophosphate dihydrate deposition disease (CPPD), hyperparathyroidism, hemochromatosis, hypophosphatemia, acromegaly, gout, Wilson’s disease, and alkaptonuria. The clinical manifestations of CPPD are varied, and are due to precipitation of calcium pyrophosphate dihydrate crystals in the connective tissues. CPPD is a polyarticular disorder, although it can initially be monarticular. Patients usually present with painful inflammation in one or more joints. Chondrocalcinosis is seen as calcifications of both the fibrocartilage as well as articular hyaline cartilage. These features are nicely illustrated in the hands of an adult with bilateral triangular cartilage calcifications (Figures a–c).
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Soft Tissue Lesions
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3.2
Soft Tissue Lesions
Extraskeletal Chondroma
Extraskeletal chondroma is a rare benign cartilaginous tumor that is most frequently seen in the soft tissues of the hands and feet. This lesion usually presents in adults aged between 30 and 60 years. Histologically, it is a well-circumscribed multinodular tumor that consists of mature hyaline cartilage, with areas of vascular interlobular connective tissue. Calcification is a late feature, and is more prominent in the center than the periphery of the tumor. Extraskeletal chondroma is seen as a soft tissue mass with scattered calcified foci. These features are nicely illustrated in the hand of an adult with an extraskeletal chondroma of the little finger (Figures a, b). On magnetic resonance imaging, a predominantly hyperintense signal indicative of a chondromatous lesion is present.
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Soft Tissue Lesions
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3.3
Soft Tissue Lesions
Joint Contractures
Joint contractures may be due to a variety of causes such as Dupuytren’s contracture, burns, Volkmann’s ischemic contracture, Parkinson’s disease, and even congenital disorders such as arthrogryposis multiplex congenita. Also known as claw hand, Dupuytren’s contracture causes flexion deformities of the fingers, most often affecting the ring or little finger. The cause is unknown. It occurs most often in middle-aged white men and is genetic. The palmar fascia thickens and becomes nodular, producing progressive flexion contractures of the fingers. Treatment may be non-surgical or surgical, depending on how advanced the contractures are. These features are nicely illustrated in the hand of an adult with flexion contractures of the fingers (Figure a).
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3.4
Soft Tissue Lesions
Metastatic Soft Tissue Calcification
Also known as calcific pseudogout, metastatic calcifications are seen in patients undergoing hemodialysis for chronic renal failure. These pa
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