Presentation
Direct thigh trauma in soccer game 2 weeks ago with persistent pain and disability.
Patient Data
Circumscribed lesion of the third middle anterior and lateral compartment in the left thigh at the level of the medial vastus, hyperintense on STIR with septa and trabeculae, lobulated and well-defined, on T1 is hyperintense in the capsule and hypo-intense in the central portion. In Fat Sat the periphery remains with hyper-intensity. On T2 the lesion remains hyperintense at the periphery with central iso- hypointense. Not an expansive or infiltrative appearance and poor peripheral edema. Note in the subcutaneous tissue slightly hyperintense edema.
Case Discussion
Soft tissue injuries can often simulate neoplastic processes, it is important to have clear information about whether the appearance of the lesion was preceded by a traumatic mechanism, time since injury, presence or absence of pain, growth, age and occupation.
MRI is by far one of the best methods for image (not forgetting the ultrasound and x-rays) to determine whether the injury is mainly infiltrating neighboring structures, greater accuracy in determining margins and associated inflammatory component.
Usually the appearance of an acute and subacute hematoma is an inflammatory component of high intensity on STIR sequences; high intensity on DP and FAT SAT; isointense elements on T1 with areas of low signal in GRE especially in its periphery and may or may not show inflammatory tissues adjacent to the area of injury, also characteristically it presents with a pseudo-capsule and presence of internal trabeculae in cases with more time of evolution.
Intramuscular non-neoplastic lesions usually are associated with disorganization of the fibers, and laminar fluid component subserous.
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