Thanks for the several responses I received. Though some suggested waiting it out and reimaging in another 6 weeks, and getting XRs at that time to see if there is any calcification or ossification….the consensus was to recommend biopsy.
I spoke to the referring orthopedist, who told me that the patient is already awaiting his appointment with an orthopedic oncologist I know of (so I hope to get follow up).
This mass presented spontaneously without any known trauma.
The patient is not anticoagulated.
So this all seems to be pointing more toward a risk for soft tissue sarcoma.
I hope you are all enjoying your holiday week off!
(do you detect my jealous tone?)
Hilary
****For those of you contemplating a trip to Savannah, Georgia in March….it would be great if you want to join the fun at OCAD Live 2023….let me know if you need the registration link…or, just look through the many previous emails with the information
On Tue, Dec 27, 2022 at 3:49 PM hilary umans <hilary.umans> wrote:
Although I recommended follow MRI in 6-8 weeks, this patient had repeat MRI without and with iv contrast now 10 days after his baseline MRI.I think the mass or hematoma is actually in the V medialis…not the Add Magnus…but that’s not important.
I remain confused and concerned and I need your help.
There is a larger mass with a tiny inferior nodule.
The larger component measured 5.2×3.5×3.3cm at baseline and 4.9×3.2×2.9cm now
The small inferior nodule previously measured 1.3cm in max dimension, now it is 0.6cm.
I am concerned about the nodularity at the deep lateral aspect of the mss.
While I am certain there is an intramuscular hematoma that is now slightly smaller, I don’t know if I can be certain that there isn’t an underlying neoplasm that bled that was masked by the hematoma.
What do you think / advise?
The ppt includes baseline MRI, contrast enhanced CT a few days later and this current MRI
On Wed, Dec 14, 2022 at 3:30 PM hilary umans <hilary.umans> wrote:
I read the MRI a couple of days ago…don’t think I had the temporal history.Thought the mass in the adductor looked like hemorrhage and wondered about myositis ossificans.
To me, I thought the adductor looked stripped off the medial femur, like thigh splints….suggesting injury.
But now I see he has symptoms x 3 weeks and denies trauma (for what that’s worth).
I recommended non contrast CT to look for calcification / ossification, but it was done
post-contrast….no pre-contrast.
There is peripheral high attenuation…which I presume is enhancement…I don’t
think it’s high enough to be calcification—agree?
If it’s only 3 weeks, it might be too early to see calcification.
Centrally it is 30HU.
My questions are:
1. Can I be certain this is simply hematoma? Usually we see peripheral hemosiderin, not just diffuse central dark signal….which threw me.
2. Can this be hemorrhagic tumor?
3. Any point to recalling for non-contrast CT?
4. Any point to MRI w/ and w/o contrast?
5. Should I just recommend f/u MRI or CT (which? when?)
6. Or would you recommend orthopedic oncologic consultation at this point?
