Name of the Patient : Abc Xyz Astlmn / F / 10 yrs.
Referred by : Dr. Abc Xyzarwal.
Examination : M.R.I. of the Right Leg.
CLINICAL PROFILE :
C/O swelling over the right leg (just below the knee). Suspected C/O Ewings sarcoma.
M.R.I. of the right leg was performed using the following parameters :
4 mm thick T1 Weighted and STIR coronal images.
4 mm thick T1 Weighted sagittal images.
8 mm thick T1 Weighted and T2 Weighted (with fat saturation) axial images.
There is evidence of a lobulated mass lesion surrounding the proximal right fibula at its anterior medial and posterior aspects. This lesion is hyperintense to muscle but hypointense to fat on the T1 Weighted images and hyperintense to both on the T2 Weighted and STIR images. The superior margin of this lesion is at a distance of approximately 4.0 cms distally from the knee joint and the lesion extends for about 9.0 cms supero-inferiorly.
The adjacent fibula shows cortical thickening and periosteal reaction. The medullary cavity also shows a hyperintense signal on the STIR and T2 Weighted images.
The soft tissue component is seen to straddle the anterior and posterior compartments of the right leg and is also seen to abut the right tibia. There appears to be involvement of the tibialis posterior muscle, flexor digitorum and hallucis longus muscles, extensor digitorum and hallucis longus muscle and a portion of the tibialis extensor muscle.
The anterior and posterior tibial neurovascular bundles are displaced by this lesion. No obvious vascular encasement is noted.
The MRI features are suggestive of a lesion involving the right fibula with a large soft tissue component as described and this most likely represents a neoplastic process (eg. Ewings sarcoma).