Figure 6 - uploaded by Marco Rastrelli
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Nodular fasciitis: a) Coronal and b) sagittal T2 weighted MRI scan showing inhomogeneous hypo-intense nodule (white arrows) on the medial side of the plantar fascia, extended to subcutaneous tissue. Nodular fasciitis was found at histopathology.
Source publication
The incidental finding of soft tissue masses is a
challenge for the radiologist. Benign and malignant lesions
can be differentiated relying on patient history, symptoms
and mostly with the help of imaging. Ultrasound (US),
computed tomography (CT) and magnetic resonance imaging
(MRI) become fundamental in order to distinguish these
lesions but the...
Context in source publication
Context 1
... shows masses extending along fascia, whose appearance reflects the different subtypes; cellular lesions are iso-intense in T1 weighted images and hyper-intense in T2 weighted images while fibrous lesions due to their collagenous components are invariably hypo-intense. Diffuse contrast enhancement is usually seen (Figure 6) (6). ...
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Modern high-performance computed tomography (CT) scanners with improved scan acquisition times now allow for routine assessment of cardiac pathologies on chest CTs, which can result in numerous incidental cardiac findings. The CaPaCT study, an observer blinded, single-centre study, aims to assess the visibility, management and possible clinical imp...
Citations
... Hematomas on US appear as avascular echogenic masses early on, and can contain a variable amount of internal echoes during the first month. 2 Over time, the hematoma should decrease in size and complexity, becoming anechoic. On computed tomogra-will have decreasing density over time as the blood products liquify which can be quantified with Hounsfield units. ...
... 1) typically have high T1 signal intensity that does not suppress with fat-suppression images, due to the release of methemoglobin from red blood cell breakdown. 2 Chronic hematomas can have a hemosiderin rim which can be detected with a gradient echo recall sequence. Administering contrast is helpful in showing the characteristic peripheral rim enhancement of the hematoma. ...
Soft tissue lesions are commonly encountered and imaging is an important diagnostic step in the diagnosis and management of these lesions. While some of these lesions are true neoplasms, others are not. These soft tissue tumor mimickers can be due to a variety of conditions including traumatic, iatrogenic, inflammatory/reactive, infection, vascular, and variant anatomy. It is important for the radiologist and clinician to be aware of these common soft tissue tumor mimickers and their characteristic imaging features to avoid unnecessary workup and provide the best treatment outcome.
Explores different Tumour mimics in MSK Imaging
Second Opinion is a difficult problem for every doctor put in this situation. In this position, we must not let ourselves be influenced, in any way, by the judgment of the first clinician, who formed a diagnosis. But not judging the “evidence” that led to the formation of the first diagnosis is difficult. This case presentation reveals the influence of a diagnosis assumed to be correct from the first interpretation. The patient, from the rural area, presents herself to the doctor following a trauma from falling down the stairs. A soft tissue ultrasound is performed and it is interpreted to be a hematoma. Afterwards, the lesion stagnates in size without progressing towards resorption. After repeating the ultrasound, its interpretation is influenced by the first ultrasound investigation supporting the same diagnosis. As a result, the patient is not guided to make a radical therapeutic decision. The presentation in our clinic was decided by the patient for a “second opinion” and, as a result, all the investigations carried out did not take into account the results previously stated by the patient during the clinical examination in the specialized outpatient clinic. The tumor was one with unimpressive dimensions but disturbing in appearance, without influencing the functionality of the forearm. The patient does not complain of pain or paresthesia in the area occupied by the tumor. She was clinging to deep plans and immovable in front of them.
Background/aim:
Certain types of soft-tissue tumors are sometimes combined with bleeding, resulting in difficulty distinguishing them from a mere hematoma when patients with unnoticed soft-tissue tumor sustain trauma.
Case report:
A 43-year-old man presented with left calf pain after running practice. Magnetic resonance imaging (MRI) revealed that the lesion seemed to be a soft-tissue mass with surrounding edema, located between the soleus and medial gastrocnemius muscle. An unnoticed soft-tissue tumor with traumatic bleeding was suspected. Two weeks later, MRI revealed that the bleeding had decreased, and the mass had changed to hyperintense on T1-weighted MRI, with heterogenic intensity on T2-weighted MRI. The calf pain had nearly almost resolved.
Conclusion:
Changes in MRI findings of traumatic hematoma over time are important for the diagnosis. In particular, changes in the intensity of the mass in the subacute phase from the acute phase must be considered when determining the possibility of traumatic hematoma.
