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Age / Sex : /
Age / Sex : 31/F
Chief complaint : Swelling of both lower legs for a week.
1) What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case.
* Send Application Answers to Ja-Young Choi, MD (drchoi01@gmail.com)
Courtesy : Kyung Jin Suh, MD., Dongguk University, College of Medicine Gyungju Hospital
Diagnosis: Eosinophilic fasciitis
Discussion
Findings:
Axial T2-weighted fat-suppressed fast spin-echo MR image shows moderately increased signal intensity within superficial and deep fascial layers and minimally increased T2 signal intensity within superficial muscle fibers adjacent to fascia in both lower legs. Axial enhanced T1-weighted fat-suppressed spin-echo MR image shows moderate fascial enhancement corresponding to T2 signal abnormalities in both lower legs.
Differential Diagnosis:
- Necrotizing fasciitis: MRI signal changes are usually not symmetric, and fascial thickening with contrast-enhanced muscular edema may be present. In addition, MR images of necrotizing fasciitis frequently show fluid collections, abscess formation, and cellulitis.
- Scleroderma clinically
Diagnosis: Eosinophilic Fasciitis
Discussion:
Eosinophilic fasciitis is a relatively rare, scleroderma-like disorder that typically presents with marked extremity edema followed by skin induration. Symptoms of stiffness, swelling, and pain often present suddenly, frequently after strenuous activity. Eosinophilic fasciitis is poorly understood and clinically characterized by the presence of peripheral eosinophilia, hypergammaglobulinemia, elevated sedimentation rate, and scleroderma-like skin findings involving primarily the extremities. A distinctive feature of this disease is its responsiveness to corticosteroid therapy, underscoring the need for early diagnosis and treatment. I have shown the MRI findings in active eosinophilic fasciitis to be highly characteristic and to include fascial thickening, hyperintense signal within the fascia on fluid-sensitive sequences, and fascial enhancement after IV contrast administration.
References:
1. Moulton SJ, Kransdorf MJ, Ginsburg WW, Abril A, Persellin S. Eosinophilic fasciitis: spectrum of MRI findings. AJR Am J Roentgenol. 2005;184(3):975-978
2. Baumann F, Brühlmann P, Andreisek G, Michel BA, Marincek B, Weishaupt D. MRI for diagnosis and monitoring of patients with eosinophilic fasciitis. AJR Am J Roentgenol 2005;184(1):169-174
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