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Nodular fasciitis

Case contributed by Dr Erik Ranschaert

Presentation:

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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