Weekly Case

Title : Case 598

Age / Sex : 68 / F


Chief complaint : Palpable mass (History of breast cancer)

What is your impression?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).

Courtesy : 
Soo-Jung Choi, Gangneung Asan Hospital


 



Discussion


Answer:  Muscular sarcoidosis


 


Findings: There is a well enhancing tubular mass like lesion with T1 high SI in the medial gastrocnemius muscle. Central star shaped scar (T1 low SI portion) is noted on axial images and three stripe sign is noted on coronal images.


 


Differential Diagnosis:


muscular sarcoidosis


intramuscular metastasis/lymphoma


fibromatosis (desmoid tumor)


 


 


Discussion: Muscular sarcoidosis


 


Muscular involvement of sarcoidosis is rare and occurs in two forms: nodular and myopathic. In the nodular variety, patients have single or multiple nodules in the skeletal muscles.


In the nodular type of muscular sarcoidosis, the lesions were long and extended along muscle fibers. Axial MR images showed a star-shaped central structure of decreased signal intensity. Coronal and sagittal MR images showed three stripes, including an inner stripe of decreased signal intensity and outer stripes of increased signal intensity. After IV injection of gadopentetate dimeglumine, contrast-enhanced MR images showed enhancement in the peripheral area of the lesions of the nodular type. On sonograms, the central structure was hyperechoic and the peripheral area was hypoechoic relative to surrounding tissue.


 


 


References:


S Otake. Sarcoidosis involving skeletal muscle: imaging findings and relative value of imaging procedures. AJR 1994;162:369-375.



Correct Answer
Total applicants 34 Correct answers 17
Name Institution
윤재성 서울아산병원, 전문의
김기욱 국군대전병원, 전문의
김유진 전문의
윤유성 삼성서울병원, 전문의
박선영 한림대학교 성심병원, 전문의
오은선 서울 순천향대학병원, 전문의
김창현 전문의
이혜란 전문의
김보람 전문의
이지현 삼성서울병원, 전문의
이규홍 삼성서울병원, 전문의
최형인 국군의무학교, 전문의
노윤화 전공의
안준형 공중보건의, 전공의
남태훈 국군서울지구병원, 전문의
이승민 전문의
한유비 공보의, 전문의


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