#RareCase Hemangioma Of The Median Nerve
A 14-year-old female patient presented to the hospital with painful swelling in the volar surface of the right wrist of 3 years duration, associated with tingling and numbness in the thumb, index, middle and radial half of the ring fingers, difficulty in writing long paragraphs. No history of Trauma reported.

Physical examination revealed a tender, soft mass, 3 × 5 × 2 cm in dimension in the volar aspect of the right wrist. Tinel sign was positive. MRI revealed a 3 × 2 × 1.5 cm ovoid rapidly enhancing mass in the volar surface of the right wrist region.

Patient was admitted for surgical treatment under the diagnosis of volar ganglion causing CTS.

Surgical exploration revealed a yellowish brown soft tissue mass with areas of hemorrhage and dimensions of approximately 4 × 3 × 1.5 cm, originating from the volar surface of the median nerve with intraneural extension and adhesions to the surrounding tissues. The mass was removed totally by interfasicular and epineural microsurgical resection technique, without structurally damaging the nerve fibers. The symptoms were relieved in the first three weeks after the operation.

Points Worth Discussion:-
1. The carpal tunnel syndrome (CTS) is the most common neuropathy due to compression seen in adults. There are very few cases in the literature referring to patients of paediatric age
2. Benign intraneural hemangioma originating from peripheral nerves is rare. Most patients present in with a painful, soft mass along the path of a nerve with signs and symptoms of nerve compression and entrapment.
3. In the differential diagnosis, lipoma, lipofibroma, hamartoma and intraneuronal Schwannoma must be considered.
4. Hemangioma shows a hyperintense signal on T1- and T2- weighted images with fat suppression sequences. Flow voids are usually apparent and feeding vessels may be visualized.

Source: https://jbppni.biomedcentral.com/articles/10.1186/1749-7221-3-5
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