Presentation
Thigh pain after a traumatic motor task (sports injury).
Patient Data
Interstitial edema is noted at the right adductor longus muscle consistent with a muscle strain. The length of this strain is about 100 mm and the maximum involvement of the cross-section is between10-50% (grade 2a injury according to the BAMIC/BAM classification).
The maximum involvement is seen at the lateral myofascial interface of the muscle involving its proximal half and there is a small volume of fluid/ hematoma between the lateral surface of the adductor longus muscle and femoral vessels. These findings suggest perivascular involvement.
As well, an intermediate signal at the undersurface of the proximal origin of common adductor-rectus abdominis (CA-RA) aponeurosis at the left side suggests chronic injury/chronic overuse.
Mild edema at the right and left sub gluteus medius bursae as well as subtle stress changes at the inner aspect of right and left femoral heads are also seen.
Case Discussion
Lateroinferiorly to the adductor longus muscle, the deep femoral vessels, and the obturator nerve are located and perivascular adductor longus muscle injury is located at this point or at the anatomical region interposed between the superficial and the deep femoral vessels.
The main characterizing MRI findings of the perivascular adductor longus muscle tear include signal changes in the lateral aspect of the muscle fibers and subjacent fascia along with the distal inter-fascial fluid extension.
The mentioned changes are best detected on fat-suppressed fluid-sensitive MRI images. In transversal sequences, signal alteration mimics a pseudo-thickening of the lateral fascia and the perifascial fluid collection is especially detected between the adductor longus and vastus medialis.
The main complication of this tear is a long-standing hematoma.
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