Rice Bodies Accompanied by Tenosynovitis of the Wrist: A Case Report and Literature Review

Abstract

Rice bodies, a rare finding in clinical practice, are commonly observed in the shoulders and knees of affected individuals. However, they can occur in the wrist as well. Herein, we report a case of a female presenting with painful swelling in the right wrist that lasted with a history of carpal tunnel syndrome, rheumatoid arthritis, and history of median nerve decompression two years ago. A potential diagnosis of infectious diseases and gout was excluded through negative cultures and laboratory findings. X-rays showed no significant findings; however, magnetic resonance imaging revealed findings suggestive of rice bodies that were confirmed by additional proton dense fat-saturated imaging. The mass was then removed by extensive debridement and sent for pathological assessment, which showed multiple nodules containing fibrin and polymorphonuclear cells. The patient did not experience recurrence during the follow-up period. Rice bodies, although rare, can occur in the wrist, and this imposes several challenges associated with their diagnostic and management protocols.

Keywords: mri imaging; rheumatoid arthriitis; rice bodies; tenosynovitis; wrist.

Figure 1. Swelling at the volar aspect of the right wrist upon presentation

Figure 2. Coronal T1 image showing an isointense mass measuring 12x15 cm, extending from the distal forearm passing through the carpal tunnel and reaching the proximal palmar surface of the hand, surrounding the flexor tendons

Figure 3. Coronal T2 weighted image showing multiple small nodular structures that appear isointense to muscles inside a hyperintense T2 mass involving the flexor tendons sheath, suggestive of tenosynovitis with rice body formation

Figure 4. Rice body appearance extending from the distal aspect of the anterior compartment of the forearm to the level of the metacarpal bones

Figure 5. Axial PD Fat Sat weighted image at the level of the distal forearm reveals distention of the palmar bursae by complex material (rice bodies) against a background of fluid signal intensity

PD, proton density; Fat Sat, fat saturated

Figure 6. Axial PD Fat Sat weighted image at the level of the metacarpal heads showing extension of synovitis into the digital flexor tendon sheath of the thumb, long, ring and little fingers

PD, proton density; Fat Sat, fat saturated

Figure 7. Rice bodies extracted during the operation

Figure 8. Multiple yellowish nodules, with a smooth surface, of different sizes ranging from 0.4 to 1 cm

Figure 9. Hematoxylin and eosin stain showing rounded clusters of fibrin containing polymorphonuclear cells and karyorrhexic debris

Figure 10. Hematoxylin and eosin stain showing a thickened and fibrous synovium containing an abundant inflammatory infiltrate