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Picture of the Month Quiz

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Image of figure 2

Figure 1.

Figure 2.

A 3-month-old girl was referred to our Vascular Anomalies Center for assessment of a rapidly enlarging left hand mass. Although present at birth as a mild localized swelling, significant growth was not noted until approximately 6 weeks of age. The infant’s medical, surgical, and family history were unremarkable. Physical examination revealed a solitary, 2.5 x 3 x 2.5-cm, firm, nonmobile, subcutaneous nodule with slight erythematous to blue hue and overlying telangiectasia protruding from the left hypothenar region (Figure 1). A handheld Doppler device detected fast blood flow at the periphery. There were no other skin abnormalities. Radiographic studies completed prior to consultation were reviewed. Plain radiographs showed a mass of soft tissue origin on the ulnar side of the left hand without any associated bone defects, while ultrasonography further characterized the mass as being solid and highly vascular. Magnetic resonance imaging demonstrated an enhancing, infiltrative tumor (Figure 2). The latter result prompted an ultrasonography-guided biopsy under general anesthesia to confirm the diagnosis.

For a complete discussion of this month's case, read next month's Picture of the Month—Quiz Case. For a complete discussion of last month's case, read this month's Picture of the Month—Quiz Case.