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Case 1: 30 year old competitive weightlifter experienced pain in his upper arms. Sagitttal and coronal images demonstrate complex masses containing air and fluid-fluid levels. He later admitted to intra-muscular injections of a lipid based steroid solution to increase muscle mass.
a.	b.
Case 2: Woman presents with a nontender mass above the elbow. Sagittal and post contrast axial images reveal an unusual venous aneurysm of the cephalic vein. (Woman recalled a recent history of venipuncture).
a.	b.
Case 3: Six month old child with history of fever and pain left leg. Coronal and axial images demonstrate a fluid collection in the anterior compartment mimicking a soft tissue abscess. (Patient was recently administered intra-muscular injection of antibiotics for suspected soft tissue infection).
a.	b.
Case 4: Patient with a pericardial sarcoma presents for restaging after surgical resection. Coronal image demonstrates diffuse numerous seed implants in the surgical bed (large arrow) adjacent to unresected residual tumor (small arrow).

Above images are all original MR scans performed at Parkside MR Center.

Physical exam can often reveal valuable information about the etiology of soft tissue tumors. Lesions smaller than 5 cm, for example, have a very low incidence of malignancy while lesions greater than 5 cm have at least a 20% chance of being a soft tissue sarcoma.¹ Superficial lesions also have a greater likelihood of being benign as compared with deep lesions.

After physical exam, the diagnostic modality that provides the most valuable information about suspected soft tissue lesions is MRI. MRI can define the extent of the tumor and has outstanding contrast resolution. It can accurately diagnose the most commonly encountered soft tissue lesions including simple cysts, lipomas and hemangiomas. It also has a 90% specificity and 94% negative predictive value for benign lesions.² Plain films still have a role in evaluating soft tissue lesions as MRI may fail to demonstrate soft tissue calcifications and tiny gas collections.

A value of MRI that is sometimes overlooked is in the discovery of the unsuspected finding. The cases illustrated here reveal such instances.

References:
1. Rydholm A, Berg NO. Size, site and clinical incidence of lipoma. Acta Orthop Scan 1983; 54:929-934.

For more information on MR soft tissue lesions and other case studies, call us at 847-696-7900.

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