Age / Sex : 44 / M

Chief complaint: 3^rd web space palpable mass

What is your diagnosis?

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

Courtesy : 정보미 (Bo Mi Chung), 중앙대학교 병원 (Chung-Ang University Hospital)

Angioleiomyoma

Discussion

Findings:

1) Radiography: soft tissue mass at 3rd web space

2) US: well-defined heterogeneously hypoechoic mass with feeding vessel

3) MRI: heterogeneously high SI on T2-WI, iso to slightly high SI on T1-WI, poor enhancement. T2-weighted MR images shows peripheral hypointense rim, internal T2 hypointense areas suggesting signal void by vascular structures.

Differential diagnosis:

Giant cell tumor, neurogenic tumor, soft tissue sarcoma

Discussion

Angioleiomyoma is a benign smooth muscle tumor that originates in the tunica media of the veins. It can occur anywhere in the body but is most often seen in the extremities, particularly the lower leg. The most frequent complaint is simply of a mass. Pain, with or without tenderness.

Angioleiomyoma should be considered a possible diagnosis when a well-demarcated subcutaneous mass of isointense signal on T1-weighted image, heterogeneous high signal intensity on T2-weighted images with internal signal voids, and an adjacent tortuous vascular structure are seen in the soft tissue of the extremities.

References

Hye jin Yoo et al., Angioleiomyoma in Soft Tissue of Extremities: MRI Findings, AJR 2009; 192:291–294

Bo Seong Jeong et al., Radiologic Findings of an Angioleiomyoma of the Finger: A Case Report. J Korean Soc Radiol 2011;64:599-602