Presentation
1 year history of a lump over the right posterior chest wall, too hard for lipoma on palpation.
Patient Data
Motion degraded scan.
Within the limitations, there is a soft tissue lesion up to 4.8 x 2.7 x 6.3 cm inseparable from lower aspect of right latissimus dorsi muscle with well defined margins inferiorly and more ill-defined superiorly. The lesion is roughly isointense to muscle on T2WI and shows heterogenous signal on T2WI and STIR. Minor soft tissue edema adjacent to the lesion.
No osseous invasion of the adjacent 11th rib.
Incidental partially visualized horseshoe kidney and right pleural effusion.
Heterogeneous low echogenicity lesion contained within the right latissimus dorsi, as demonstrated on MRI. Minimal central blood flow.
3 x 16G core biopsies were obtained concurrently.
Case Discussion
This patient was referred for an MRI following a GP review of a lesion on the back, features inconsistent with lipoma.
The MRI demonstrated no features of lipoma; therefore, the concern was raised of possible soft tissue tumor and referral was made to local sarcoma center. An ultrasound guided biopsy was then performed.
The core sample comprised spindle cells with some ganglion-like cells embedded in dense fibrous stroma, consistent with a low grade myofibroblastic lesion and represent ischemic fasciitis.