This is a 37M with history of Psoriatic Arthritis and Crohn’s disease, on
Amitriptiline, Dicyclomone, Metformin, Humira, recently started Otezla.
Few weeks of painful plantar medial foot lump, no trauma.
Initial non contrast MRI Feb 10.
Returned for contrast MRI and US Feb 12.
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Initial MRI reported as “probable neural based tumor, recommend contrast”.
The mass does not enhance at all centrally, there is a thin rind of
peripheral enhancement.
I considered a thrombosed medial plantar vein and recommended the US…both
the tech and I scanned.
The mass is hypoechoic with min posterior acoustic enhancement and vessels
draping around it.
This is unrelated to the vein.
I couldn’t trace the nerve or the vein to the mass.
I think the mass is in the intermuscular fat and, esp in the follow up MRI
there is a little bit of Bright T1 signal on T1 and T1-FS pre images.
My best guess is hemorrhagic fat necrosis…but I’m not sure.
I’ve recommended f/u US in 6 weeks.
What do you think / advise?
Hilary
37M-few-weeks-painful-med-forefoot-mass.pdf
