Case Challenge

Stephen J Pomeranz

Interact with scrollable cases and watch microlearning videos with MRI Online. Gain confidence interpreting Thigh MRI Cases & earn CME. Try it free!

Case Review

Musculoskeletal (MSK)

Case 1 - 14-year-old male football player presents with posterior bruising in the upper right leg

Case 2 - 89-year-old female presents with growth on right thigh

Case 3 - 61-year-old female presents with a painful mass in the left distal thigh

Case 4 - 92-year-old male is being assessed for infection of amputated leg

Case 5 - 57-year-old male is being evaluated for ischial avulsion fracture

Case 6 - 57-year-old male presents with left thigh strain / muscle defect

Case 7 - 68-year-old female presents with numbness involving both legs

Case 8 - 18-year-old male presents with contusion of left thigh, and paresthesia

Case 9 - 31-year-old male presents with right thigh pain, and history of fracture

Case 10 - 55-year-old female presents with contusion

Case 11 - 8-year-old female is being evaluated for a distal left femur mass

Case 12 - 60-year-old male presents with left thigh pain

Case 13 - 50-year-old male presents with sickle cell crisis, and extreme pain in left thigh

Case 14 - 48-year-old male presents with history of arthroscopic surgery on the right knee

Case 15 - 45-year-old male presents with soft tissue mass in left thigh

Case 16 - 3-year-old female presents with asymmetric thighs, left greater than right

Case 17 - 11-year-old male presents with posterior pain to right mid-thigh

Case 18 - 38-year-old female presents with persistent left leg pain

Case 19 - 14-year-old male presents with myotendinous injury in the left thigh

Case 20 - 55-year-old female presents with left leg weakness

Case 21 - 54-year-old male presents with a large left thigh mass

Case 22 - 86-year-old male presents with lump in left thigh

Case 23 - 55-year-old male presents with clinical strain at the hamstring muscle insertion

Case 24 - 66-year-old male is being evaluated for a right distal thigh mass

Case 25 - 77-year-old female presents with a left thigh soft tissue mass

Course Evaluation

Post-Course Activities

This Power Pack is comprised of 25 unique Thigh MRI cases that you can scroll through in our diagnostic web viewer to determine your findings. Quiz yourself and earn CME.

Thigh MRI Cases

<div>HISTORY:&#160;This 60-year-old male presents with left thigh pain.(QUIZ ANSWER) SPARED:&#160;Gracilis and sartorius.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS: Current MRI demonstrates extensive signal alteration involving inner thigh muscles with involvement of the adductor longus, magnus and minimus and with sparing of the sartorius and gracilis. Also noted is involvement of the lateral head of the gastrocnemius (innervated by the tibial nerve, a branch of the sciatic nerve). The appearance of the sciatic nerve is normal at the level of the posterior hamstring complex origin (near the inferior ischial tuberosity). On T1 weighted images, morphology is unremarkable. However, on fluid sensitive imaging, there is diffuse T2 prolongation without evidence for epimysial fluid or surrounding fascial edema.&#160;&#160;Muscle signal intensity abnormalities are nonspecific and although no focal lesion is seen, the findings could be due to entrapment of the obturator nerve in the proper clinical context. Remainder of the differential diagnosis for alteration of muscle signal intensity includes myositis (infectious or toxic including inclusion body disease), autoimmune, inflammatory myositis (polymyositis dermatomyositis) and other inflammatory myopathy. May even consider paraneoplastic syndrome in the appropriate context. The remaining muscle groups are intact without evidence for alteration in T1 or T2 signal or internal morphology.&#160;Normal femur and normal appearance of its periosteal and endosteal cortex and cancellous bone.&#160;Normal superficial soft tissues.&#160;No discrete soft tissue mass and no abnormal fluid collection.&#160;Edge of film finding includes T1 hypointensity involving the ischial tuberosity and inferior pubic ramus. May consider dedicated imaging of the pelvis for more accurate evaluation of osseous status.&#160;CONCLUSION:&#160;1. Diffuse signal intensity alteration on fluid sensitive imaging involving the medial thigh muscles including adductor longus, adductor magnus and adductor minimus with sparing of the gracilis and sartorius. Also noted is involvement of the lateral head of the gastrocnemius (innervated by the tibial nerve, a branch of the sciatic nerve). The appearance of the sciatic nerve is normal at the level of the posterior hamstring complex origin (near the inferior ischial tuberosity). In the absence of trauma, an extensive differential diagnosis is given above. Correlate clinically.&#160;2. No soft tissue mass, fluid collection or osseous abnormality within the femur including cortical and cancellous bone.&#160;3. Consider assessment of lumbosacral plexus.</div>

Case

Adductor longus, adductor magnus, and adductor minimus

In this case, there is diffuse signal intensity alteration on fluid sensitive imaging involving the medial thigh muscles. Which of the following was spared?