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Age / Sex : 39 / F
Chief complaint : Palpable masses at both elbows and left knee
What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case. (Please submit only one answer)
Courtesy : Yu Mi Jeong, Gachon University Gil Hospital
Diagnosis: Sarcoidosis
Discussion
Findings: Relatively
well-defined, homogeneously enhancing soft tissue mass, slightly hyperintense
on both T1-/T2-WI, in subcutaneous layer of forearm.
Differential Diagnosis:
Benign soft tissue tumors such as nodular
fasciitis, foreign body granuloma, fibromatosis, vascular tumors, and
neurogenic tumors.
Soft tissue sarcoma
Lymphoma
Diagnosis:
Subcutaneous sarcoidosis (Noncaseating granulomatous inflammation with langhans
giant cells, consistent with sarcoidosis ).
Discussion:
Sarcoidosis is an inflammatory granulomatous
disease of unknown cause. It involves multiple organs, most commonly the lungs,
lymph nodes, skin, and eyes, but may be clinically evident in any organ system,
including the musculoskeletal system. Skeletal involvement has been reported in
1%–13% of sarcoidosis patients, with an estimated average of 5%. Subcutaneous
involvement also has been reported, and its appearance may be nodular or
diffuse. Nodular lesions are well-defined and homogeneous, and usually
isointense to muscle showing enhancement. Diffuse lesions show a strip or mesh
pattern with intermediate signal intensity on both T1- and T2-weighted images, and
slight enhancement.
In case of nodular lesions, differential
diagnosis includes other benign and malignant mesenchymal subcutaneous masses
including nodular fasciitis, foreign body granuloma, fibromatosis, vascular
tumors, neurogenic tumors, and even lymphoma.
In case of
diffuse lesions, panniculitis and panniculitis-like lymphoma should be
considered in the differential diagnosis.
References:
1) Shinozaki T1, Watanabe H, Aoki J, et al. Imaging
features of subcutaneous sarcoidosis. Skeletal Radiol. 1998;27(7):359-64.
2) KH Choi, YS
Choi, et al. A nodular type of subcutaneous sarcoidosis:
a case report. J Korean Soc Radiol. 2009 ;60(1):47-50.
3) Moore
SL, Teirstein A, Golimbu C. MRI of Sarcoidosis patients with musculoskeletal symptoms.
AJR. 2005;185(1):154-9.
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