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| IMAGE QUIZ ARCHIVE | ||||||
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| Leg Pain and Swelling in an Adult1 | ||
| Harish S. Hosalkar, MD, Julieta Barroeta, MD, Neil A. Roach, MD, Murray K. Dalinka, MD, Richard D. Lackman, MD*, Departments of Orthopaedic Surgery and Pathology and Radiology, University of Pennsylvania, Philadelphia, Pennsylvania. E-mail address for R.D. Lackman: rilack@pahosp.com | ||
| A thirty-year-old man presented with a mass in the right calf of about fifteen years' duration. Over the previous three to four years, the mass had enlarged and become tender to touch. The remainder of the patient's personal and family history was noncontributory. | ||
| On examination, the patient was in no apparent distress and had a normal gait. Examination of the right calf revealed posterior and lateral fullness in the calf, which was consistent with an underlying mass. There was no erythema and the mass was not pulsatile, although it was tender to deep palpation. The right knee had a full range of motion with no instability or tenderness. There was a full active range of motion of the ankle and foot. The neurovascular system was intact. Imaging examinations were performed and included plain radiographs (Figs. 1-A and 1-B), a radionuclide bone scan (Fig. 2), and magnetic resonance images (Figs. 3-A through 3-C). | ||
 Fig. 1-A |
 Fig. 1-B |
Anteroposterior (Fig. 1-A) and oblique plain radiograph (Fig. 1-B) of the right leg, demonstrating a lesion of the proximal part of the fibula with an aneurysmal expansion and a cystic appearance. For larger view, click on image |
 Fig. 2 |
Fig. 2 Radionuclide bone scan demonstrating marked accumulation of radionuclide in the mass on the delayed image. For larger view, click on image |
|
 Fig. 3-A |
 Fig. 3-B For larger view, click on image |
 Fig. 3-C |
| Figs. 3-A through 3-C T1-weighted sagittal images (repetition time = 600 msec, echo time = 10 msec) (Figs. 3-A and 3-B), demonstrating a lobulated, well-defined, slightly inhomogeneous mass that approximates the intensity of muscle. The T2-weighted fast-spin-echo coronal images (repetition time = 5000 msec, echo time = 68 msec), obtained with fat suppression (Fig. 3-C), reveal a markedly heterogeneous mass, primarily hyperintense and containing cystic areas as well as signal voids. | ||
| A biopsy was performed (Figs. 4-A and 4-B). | ||
 Fig. 4-A |
 Fig. 4-B |
For larger view, click on image |
| What is the diagnosis? | ||
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