Synchronous multicentric aggressive fibromatosis does not appear to have been previously reported. Two such cases are described. The tumors were identified by magnetic resonance (MR) imaging. The incidence of synchronous multicentric aggressive fibromatosis is not known. It is anticipated that increased use of coronal MR imaging will reveal more tumors of this type, both synchronous and metachronous. In a patient with known or suspected aggressive fibromatosis, every other soft tissue nodule or mass in the same limb has to be regarded as an additional tumor of the same histology.
Body computed tomographic (CT) scans were reviewed in 73 patients with hematomas of recent onset. The incidence, extent, and morphologic variation of regions of hyperdensity on precontrast scans were assessed. Hyperdensity was also sought in the scans of 80 control subjects with a mass due to neoplasm or abscess demonstrated at CT. Of the 73 hematomas 55 (75%) exhibited regions of localized or diffuse hyperdensity. Only one of the 80 (1.25%) control lesions showed relative hyperdensity that could not be explained by obvious calcification, bone fragments, or diminished density of the organ of origin. Predominant hyperdensity throughout the lesion was present in 35 (48%) of the hematomas and in 16 (22%) of these was homogenous in texture. Other patterns of hyperdensity included linear shadows, hyperdense filling defects surrounded by fluid, dependent position of hyperdense fragments, and fluid fluid levels with dependent hyperdensity. Hyperdensity at CT was due to the high hemoglobin content of retracted clot or sedimented blood. The various patterns seen can be related to sequential changes occurring in blood following hemorrhage. Relative hyperdensity and its variations seen on precontrast scans are useful diagnostic signs of recent hemorrhage.
A review of the radiographs of 60 hemophilia patients showed nine (15%) with ectopic new bone formation. Three of these patients had multiple sites of involvement. The high frequency discovered in this series contrasts with the paucity of descriptions to be found in the literature. This process of myositis ossificans affects the lower half of the body and probably represents dysplastic metaplasia developing at the site of an intramuscular hematoma when remote from bone, as well as ossification of hemorrhagic lesions related to the periosteum. In conventional radiographs anatomic localization of bone foci is difficult, but use of computed tomography permits precise identification of the affected muscle. There is negligible disability associated with this condition.
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