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 3-year-old female presents with asymmetric thighs, left greater than right.&#160;Pain.&#160;Left femur muscle cramps.&#160;No palpable mass.(QUIZ ANSWER) LEAST LIKELY PRIMARY FINDING:&#160;Epithelioid hemangioendothelioma.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS:&#160;A 4.2cm in transverse diameter by 3.34cm in AP diameter. Mass circumscribes the femur, but does not invade or destroy.&#160;The proximal to distal length is 7.42cm.&#160;Heterogeneous signal intensity with modest T1 hyperintensity and scattered globular areas of T2 hypointensity suggest a lymphovenous anomaly or malformation.&#160;Other considerations include mixed vascular malformation (low-flow state), hemangioma, hemangioendothelioma, and epithelioid hemangioendothelioma more commonly seen in bone).&#160;Although the femur is not involved, the lesion is centered in the vastus intermedius.&#160;Nearly 360 degrees of femoral encasement is noted although the posterior femur and linea aspera are spared.&#160;CONCLUSION:&#160;Deep femoral soft tissue mass centered in the vastus intermedius for which a vascular etiology such as a lymphovenous malformation, lymphocavernous malformation, or one of the family of vascular neoplasms such as hemangioma, hemangioendothelioma, and least likely epithelioid hemangioendothelioma are favored.</div>

Case

In this case, there is a deep femoral soft tissue mass centered in the vastus intermedius. The LEAST LIKELY differential would be which of the following?