EURORAD ESR

Case 12203

Calcific myonecrosis - a 'do not touch' lesion

Author(s)
Shah A1, Heir MK1, Botchu R2, Rennie WJ1

1University Hospitals of Leicester,
Department of Radiology;
Infirmary Square LE1 5WW Leicester;
2Royal Orthopaedic Hospital,
Birmingham, B31 2AP
 
Patient
male, 64 year(s)
 
 
  • Figure 1
    Plain radiograph of the right lower leg

    AP radiograph demonstrates soft tissue mass with rim calcification with erosive changes of the fibula (red arrows).

     
    Area of Interest: Musculoskeletal bone; Imaging Technique: Conventional radiography; Procedure: Diagnostic procedure; Special Focus: Calcifications / Calculi;
     
     
  • Figure 2
    CT 3D reconstructions

    CT 3D reconstructions demonstrating a large soft tissue mass in the anterolateral aspect of the lower leg. There is marked peripheral calcification with erosive changes of the adjacent fibula.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Trauma;
     
     
  • Figure 3
    Axial post contrast CT of the lower leg

    Axial CT on soft tissue windows, demonstrating a large soft tissue mass with peripheral calcification and erosive changes of the adjacent fibula. Intralesional areas of high attenuation (arrows) represent haemorrhage.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Blood;
     
     
  • Figure 4
    3D CT angiogram reconstruction

    CT 3D reconstruction demonstrating collaterals feeding vessels supplying the large soft tissue mass demonstrating how vascular calcific myonecrosis is.

     
    Area of Interest: Musculoskeletal system; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Trauma;
     
     
  • Figure 5
    MRI lower leg

    T1 axial and coronal demonstrating mixed signal intensities in keeping with mixed acute/chronic blood with peripheral frond-like thick wall. Fibula scalloping seen (arrows).

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Blood;
     
     
  • Figure 6
    MRI lower leg

    Axial T2 demonstrating fluid-fluid levels in keeping with layering of blood and solid/cystic areas with peripheral low signal indicating calcification and layering of blood.

     
    Area of Interest: Musculoskeletal system; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Blood;
     
     
  • Figure 7
    MRI lower leg

    Axial T1 fat-saturated pre-contrast (A) and corresponding post-contrast (B) images demonstrating no significant enhancement post-contrast. Fluid-fluid levels with frond-like low signal intensities were noted, in...

     
    Area of Interest: Musculoskeletal system; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Blood;
     
     
  • Figure 8
    MRI lower leg

    (A) axial and (B) coronal T1 fat-saturated images of the lower leg demonstrating no significant enhancement post-contrast.

     
    Area of Interest: Musculoskeletal system; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Blood;
     
     
AP radiograph demonstrates soft tissue mass with rim calcification with erosive changes of the fibula (red arrows).
 
CT 3D reconstructions demonstrating a large soft tissue mass in the anterolateral aspect of the lower leg. There is marked peripheral calcification with erosive changes of the adjacent fibula.
 
Axial CT on soft tissue windows, demonstrating a large soft tissue mass with peripheral calcification and erosive changes of the adjacent fibula. Intralesional areas of high attenuation (arrows) represent haemorrhage.
 
CT 3D reconstruction demonstrating collaterals feeding vessels supplying the large soft tissue mass demonstrating how vascular calcific myonecrosis is.
 
T1 axial and coronal demonstrating mixed signal intensities in keeping with mixed acute/chronic blood with peripheral frond-like thick wall. Fibula scalloping seen (arrows).
 
Axial T2 demonstrating fluid-fluid levels in keeping with layering of blood and solid/cystic areas with peripheral low signal indicating calcification and layering of blood.
 
Axial T1 fat-saturated pre-contrast (A) and corresponding post-contrast (B) images demonstrating no significant enhancement post-contrast. Fluid-fluid levels with frond-like low signal intensities were noted, in keeping with differently aged blood products.
 
(A) axial and (B) coronal T1 fat-saturated images of the lower leg demonstrating no significant enhancement post-contrast.
 
 
 
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