Presentation
Urgent ultrasound requested by general practitioner for cancerophobic young man with a palpable "mobile" solid nodule in the right upper thigh.
Patient Data
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Ultrasound shows a subcutaneously located sharply demarcated hypoechoic solid lesion. Color doppler shows mild increase internal vascularity.
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A sharply demarcated ovoid lesion in the subcutaneous tissue with signal iso-intense to muscular tissue. Sagittal T1 image well demonstrates the superficial location in the upper thigh and the homogeneous hypo-intense signal comparable to muscle. Sagittal T2 FS well demonstrates the homogenous T2 hyperintensity of the lesion. Late series after IV contrast administration show mild enhancement of the lesion. Dynamic contrast enhancement curve showing a slow linear uptake of gadolinium (type 1 pattern).
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 lesion 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 fat saturation 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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