Complete chronic tear of distal adductor longus muscle with pseudomass formation
Presentation
History of sudden severe pain 1 year ago while playing football, which reduced spontaneously. Now, presents with swelling in the right upper medial thigh for 3 months.
Patient Data
MRI of right thigh shows non-visualization of the distal third of adductor longus muscle (as compared to contralateral muscle on left side in T1w axial image) - representing chronic complete tear of distal adductor longus muscle.
Mid third of the adductor longus muscle is retracted and bulky (forming "pseudomass") with focal T1w hyperintense intramuscular fatty deposits. This corresponds to the clinically palpable swelling in the upper, medial right thigh.
No mass lesions are seen in the upper/mid thigh.
Axial non-contrast CT images of both upper thigh show chronic tear of the distal third of right adductor longus muscle (as evidenced by its non-visualization) with retracted, bulked-up mid third of muscle forming pseudomass.
Fatty streaks are seen in the retracted, bulked-up mid third of muscle with two punctate foci of calcifications at the tear site.
Comparison can be done with normal appearing left adductor longus muscle.
Case Discussion
35 year old with a history of football-related injury with severe, sudden transient pain in right thigh 1 year back presents with swelling in right upper, medial thigh.
MRI and CT images of the thigh show a chronic complete tear of distal right adductor longus muscle with retracted, bulked-up mid portion of muscle resulting in pseudomass formation (corresponding to clinically palpable swelling).
Acute and chronic tears of the adductor group of muscles are usually seen during athletic activity, more so if done without prior preconditioning.
Adductor longus is the most commonly injured adductor muscle. It arises from superior pubic ramus with broad-based insertion into mid femur along linea aspera.
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