Fibrolipomatous hamartoma is a rare benign tumour most commonly affecting the median nerve and is characterised by fibro-fatty nerve infiltration. It results in fusiform nerve enlargement with a pathognomonic ‘spaghetti-like’ imaging appearance. Patients present with numbness and paraesthesia and later with motor deficits in the affected nerve distribution. The condition frequently coexists with macrodystrophia lipomatosa in up to two-thirds of cases.

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