Soft tissue pseudotumours: a pictorial review with emphasis on MRI

Abstract

Background: Several tumour-like conditions of the soft tissues may be encountered in clinical practice, or when patients undergo radiologic examinations. Although advances in cross sectional imaging (ultra-sound, MDCT and MRI) play a pivotal role in the correct evaluation of tumour-like lesions, a systematic approach is needed to achieve a definitive diagnosis or limit the differential diagnosis. Clinical history, physical examination and anatomic location are of paramount importance. Methods: In this pictorial essay we review some of the most frequent benign soft tissue conditions which may be mistaken for malignancy and thus lead to needless referrals, unnecessary biopsies and great anxiety to the patients and their carers. Level of evidence: IV.

Effect of extensive tenosynovectomy on diffuse flexor hallucis longus tenosynovitis combined with effusion

“…The inflammatory signal changes in the tendon sheath are usually correlated with edema in the surrounding soft tissues, and T1-weighted postgadolinium injection sequences are particularly useful to distinguish the thick tenosynovium from the surrounding structures. 14…”

“…The inflammatory signal changes in the tendon sheath are usually correlated with edema in the surrounding soft tissues, and T1-weighted postgadolinium injection sequences are particularly useful to distinguish the thick tenosynovium from the surrounding structures. 14 When treatment is required due to pain or appearance complaints caused by tenosynovitis and effusion, the most common conservative treatments are performed including Figure 2. MRI images (1.5 T) before surgery and 1 year after surgery.…”

Myotendinous pseudomasses: an imaging review

“…Variants of the palmaris longus, extensor digitorum brevis manus, and accessory soleus are the commonly described anatomical muscle variants that may be misinterpreted as soft-tissue swelling. An accessory head of gastrocnemius can cause popliteal artery entrapment syndrome while anconeus epitrochlearis and accessory flexor digitorum longus can cause entrapment of the ulnar and tibial nerves, respectively (1,10).…”

“…USG is not sensitive for the detection of acute denervation. In chronic cases, apart from identifying the atrophied muscles, the course of the supplying nerve should be examined carefully to look for masses compressing on the nerve, entrapment syndromes, or nerve sheath tumors (1,10) (Fig. 9).…”

“…These include muscle/myofascial hernia, retracted muscle or tendon tears, benign hypertrophy, accessory muscles, tendon xanthomas, diffuse myositis, and exertional compartment syndromes. On the other hand, in cases of unilateral atrophy or postoperative status, the normal-sided muscle may appear as a mass on imaging (1). These pseudomasses are a group of relatively rare, non-tumoral “non-mass” diseases of the muscles, tendons, or overlying fascia that present as a mass clinically or masquerade as a mass on radiological evaluation.…”