4-year-old female with pain and limping

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4-year-old with limping soft tissue mass in the arch of the foot.

Long- and short-axis fat- and water-weighted images were obtained before and after contrast administration.

  • No osseous lesion. Ill-defined mass is identified within the plantar arch of the foot extending medially with irregular micronodular borders lesion has longitudinal extension roughly 6.2cm and short-axis diameter of 23 x 22mm. The lesion is situated deep to the plantar fascia originates at the level of the sustentaculum tali and has multiple central dark T2 signal nodular foci. Few very dark at T1 and T1 intense foci are also noted. Proximal margin begins at the cubital arch of the posterior tibialis with infiltration of both the flexor digitorum and flexor hallucis longus tendons.
  • Heterogeneous post-contrast enhancement. The nodular components remain lower in T1 signal (not enhancing) following gadolinium administration.
  • Reactive stress marrow edema within the base of the cuboid and portions of the lateral calcaneus.
  • Confluent multilobular plantar mass without respecting tissue planes has imaging characteristics favoring venous malformation hemangioma with multiple phleboliths. The lesion infiltrates the flexor hallucis and flexor digitorum tendons effaces the quadratus plantae and has origin along the inferomedial margin of the posterior tibialis at the tarsal tunnel arch. The lesion has exophytic subcutaneous extension alongside the abductor hallucis at the level of the cuneiforms.
  • Reactive microtrabecular edema within portions of the cuboid and medial calcaneus.

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