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Nodular fasciitis

Case contributed by Dr Erik Ranschaert


Urgent ultrasound requested by general practitioner for cancerophobic young man (22 yrs old) with palpable "mobile" solid nodule in the right upper thigh .

Patient Data:

Age: 22 years
Gender: Male
Race: Caucasian

Ultrasound upper right thigh

Modality: Ultrasound
Modality: MRI

Case Discussion:

Typical example of nodular fasciitis of the myxoid subtype.

Subcutaneous lesions tend to belong to a myxoid subtype and to be of younger age.

  • Ultrasound is helpful in determining whether the lesion is cystic or solid. The lesion can be of mixed echogenicity and sometimes the leson presents as a low-level vascular lesion on doppler ultrasound despite the intense neovascularity visible on angiography
  • On MRI the myxoid subtypes show
    • homogeneous SI comparable with normal muscle on T1
    • high SI on fatsat proton-density or T2 weighted images
    • they usually show mild to moderate enhancement, which is diffuse but slightly inhomogeneous
  • The increased T2 SI is most likely caused by fluid-filled mucoid spaces. Compact cellularity with a prominent capillary network and a myxoid pattern may be responsible for the enhancement on MRI.

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