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Age: 81

Sex: Female

Indication: Left thigh injury

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Case #17


Findings

  • Solid mass in the anteromedial left thigh measuring 12.2 x 5.6 x 11.7 cm, which is hypoechoic relative to the surrounding fat and demonstrates internal vascularity
  • Mild internal heterogeneity with several thin echogenic septations
  • The mass appears to involve the thigh musculature and extend into the subcutaneous fat


Diagnosis

Soft tissue neoplasm (solitary fibrous tumor)

Sample Report

Solid mass in the anteromedial left thigh measuring 12.2 x 5.6 x 11.7 cm, which demonstrates internal vascularity and is concerning for neoplasm. Recommend MRI with and without contrast for further assessment of the mass and of the extent to which it involves adjacent structures.


Discussion

  • This is a path-proven solitary fibrous tumor
  • Beware of the “hematoma” with internal vascularity – any masslike soft tissue lesion with internal vascularity needs further workup
  • Color (and power) Doppler are prone to artifacts including motion which can lead to the illusion of internal vascularity. If you think there is internal vascularity, spectral Doppler can improve diagnostic confidence
  • Because soft tissue masses usually grow slowly over time, patients may not notice them until something makes them pay more attention to the area – like trauma. Unfortunately, this can confuse the clinical picture and lead to mistakenly writing off the mass as a traumatic hematoma
  • It’s best to be careful with suspected hematomas even when there isn’t clear internal vascularity. Recommend clinical followup and repeat imaging if the palpable mass does not resolve


Images

Followup MRI in this patient demonstrates an enhancing mass in the medial compartment of the left thigh (red arrow).

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