We present the case of a 33-year-old woman who presented with a slowly enlarging mass over the volar aspect of the wrist that had been present since infancy which for the previous year had been causing progressive pain. The lesion was proven to be a fibrolipomatous hamartoma, a rare benign tumor that most commonly affects the median nerve. We discuss the characteristic radiologic appearance of this entity that is often pathognomonic and allows a confident diagnosis without the need for biopsy.