Presentation
Perenial swelling for months. No constitutional symptoms.
Patient Data
Initial ultrasound scan showed multiple skin and subcutaneous hypoechoic soft tissue nodules scattered at the right gluteal and perineal regions with faint vascularity noted within.
An ill-defined infiltrative soft tissue lesion is seen centered at the right perineal region extending to right gluteal muscles, medially limited by midline and associated with right sided sacral intraspinal extension mainly along right S2 nerve root.
The lesions elicit low signal in T1, heterogeneous high signal in T2 and STIR with faint heterogeneous post contrast enhancement.
Case Discussion
The cutaneous and subcutaneous location of the skin lesions and deep soft tissue extension with limitation of the extension by the midline and associated bulky sacral nerve root gives the impression of dermatomal distribution in this case.
The main differential in this age group is a venous malformation, yet lack of intense post-contrast enhancement, moderately hyperintense signal in T2 and STIR as compared to that seen in hemangiomas as well as the lack of dominant tortuous supplying vessels rendered this possibility to be less likely.