High-Resolution Ultrasound in the Evaluation of Median and Superficial Radial Nerve Involvement in Neurofibromatosis Type 1

This presentation highlights the value of high-resolution ultrasound for simultaneously characterizing superficial neurofibromas and detecting associated peripheral nerve involvement in young patients with neurofibromatosis type 1. In a 16-year-old female with hand pain and paresthesia, ultrasound demonstrated a hypervascular superficial neurofibroma together with marked epineural thickening of the median nerve, swelling of its recurrent motor branch, and edema of the superficial radial nerve. These findings provided an anatomic correlate for the patient’s symptoms despite normal median and ulnar nerve conduction studies and complemented magnetic resonance imaging, which demonstrated a plexiform neurofibroma subsequently confirmed by biopsy. Symptomatic improvement following debulking surgery further supported the clinical relevance of the imaging findings. High-resolution ultrasound may therefore provide complementary information by depicting both superficial neurofibromas and adjacent peripheral nerve abnormalities that may not be reflected by electrophysiological testing.