Sex: female
Age: 56 years

History
None pertinent.

Laboratory data
Not available.

Physical findings
Deep, painful, firm and poor circumscribed masses adherent to the skin with muscular retraction and limited joint motion and motor weakness.

Case text
Persisting soft tissue swelling involving both lower limb muscles at two locations since several months.

Image 1
CT of the thigh
(1) Axial contrast enhanced scan displayed at soft tissue window.

Image 2-3
MR imaging of both thighs
(2) Coronal T1-weighted image; (3) coronal STIR image  

Image 4-5
MR imaging of the ankle
(4,5) Fat suppressed contrast enhanced T1-weighted images in the sagittal (4) and axial (5) plane.

Image 1

1. Describe the findings.

The axial CT scan obtained at the supracondylar level of the femur shows a soft tissue mass with inhomogenous and irregular enhancement. The mass is located in the region of the muscle vastus medialis.

Image 2-3

2. Describe the findings.

There is abnormal signal in muscles of  both distal thighs. In addtion, soft tissue edema is visible at the medial distal right thigh.

Image 4-5

3. Describe the findings.

Contrast enhancement of the posterior soft tissues of the ankle is seen. The findings are consistent with an inflammatory process of the posterior malleolar space. Bopsy was performed. Histopathology revealed  A plasma cell infiltration with a clear histiocytic component and spindle shaped cells mostly bland partly somewhat atypical that formed fascicles in some areas. 

Image 4

Inflammatory pseudotumor, Image 1		Inflammatory pseudotumor, Image 2		Inflammatory pseudotumor, Image 3
Inflammatory pseudotumor, Image 4		Inflammatory pseudotumor, Image 5