Soft tissue hemangioma - distal thigh

Case contributed by Ammar Haouimi
Diagnosis probable

Presentation

Painless swelling of the distal aspect of the right thigh.

Patient Data

Age: 20 years
Gender: Female

Periosseous soft tissue mass iso-to hypodense to the muscles containing small calcification (phlebolith), displacing the adjacent muscles with periosteal reaction well-visualized on the bone window.

Well-circumscribed periosseous soft tissue mass of posteromedial aspect of the distal thigh, measuring 95 x 65 x 50 mm. It displays an isosignal to the muscles on T1, high signal on T2 and STIR with central areas of high signal on T1 and low signal on T2 and STIR (hemorrhage). The post-contrast sequences show progressive and heterogeneous enhancement. There is an adjacent periosteal reaction with displacement of the vastus intermedius and medialis, biceps femoris and adductor magnus. Encasement of the deep femoral vein and adjacent segment of the sciatic nerve.

Case Discussion

MRI features most consistent with a periosseous soft tissue hemangioma displacing the adjacents muscles with periosteal reaction and encasement of the sciatic nerve and deep femoral vein.

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