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When can I return to my normal activities?

It is not known how to prevent a Morton's neuroma. However, wearing properly fitting shoes with good padding will help

decrease the pain of a Morton's neuroma.

How can I prevent a Morton's neuroma?

Proliferative myositis Myositis ossificans.

Case reports:

Ma.Ng.M.Tung MD MRI-CT Dept.

Muscularskeletal Dept.

MEDIC Center.

A 47-year-old man with no relevant medical or surgical history presented to the CT-MRI Dept- MEDIC center with a 6-week history of a painful mass in her right arm.

Physical examination revealed a firm palpable mass in the right triceps muscle, without overlying skin changes.

Ultrasound report: Sarcoma?

MRI non CE report: Myositis ossificans.

the first HISTORY

A 65-year-old woman with no relevant medical or surgical history presented to the orthopedic clinic with a 3-week history of a painful mass in her right arm that manifested 1 week after trauma.

Physical examination revealed a firm palpable mass in the right biceps muscle, without overlying skin changes. She was afebrile.

Laboratory studies did not reveal any abnormalities.

Conventional radiography (images not shown) depicted a soft-tissue mass, without any soft-tissue calcification or skeletal abnormality. Magnetic

resonance (MR) imaging was performed.

the second HISTORY

Figure 1a: Oblique (a) sagittal and (b) coronal fat-saturated T2-weighted spin-echo MR images of the right arm (repetition time msec/echo time msec, 2410/70) show a hyperintense soft-tissue mass (arrows) in the belly of the right biceps muscle

preserving the muscle fibers (arrowheads) without disruption

MR imaging of the right upper extremity revealed a well-defined soft-tissue

mass (7.0 x 3.5 x 3.0 cm) in the belly of the right biceps muscle

Figure 2: Transverse T2-weighted gradient-echo MR image of the right arm (488/14; flip angle, 35{degrees}) shows a moderately high-signal-intensity intramuscular soft-tissue mass (arrows)

Figure 3: Sagittal T1-weighted spin-echo MR image of the right arm (600/15) shows an isointense homogeneous intramuscular mass (arrows)

Figure 4: Contrast material-enhanced sagittal T1-weighted spin-echo MR image of the right arm (600/15) shows a soft-tissue mass (arrows) with almost homogeneous enhancement preserving the muscle fibers without disruption

The keys to assigning the correct diagnosis were patient age, history of recent trauma, and a rapidly growing, painful solitary soft-tissue mass located in the substance of the biceps muscle, together with MR findings. These clinical and imaging findings were indicative of proliferative myositis (PM).

MR images of PM have been reported in several cases, with a hypo- or isointense T1 signal compared with that of muscle and homogeneous enhancement. T2-

weighted MR images typically demonstrate a hyperintense soft-tissue mass

Differential considerations for a mass involving the skeletal muscle include soft-

tissue tumors, traumatic injury, myositis ossificans, muscle sarcoidosis, and various causes of infectious and inflammatory processes.

The most common benign and malignant intramuscular soft-tissue tumors are

angiomatous lesions, lipoma, myxoma, malignant fibrous histiocytoma, and various types of sarcomas

Soft-tissue angiomatous lesions and lipomas can be diagnosed confidently on the basis of their specific signal intensity and morphologic characteristics on MR images.

Typically, T1-weighted MR images demonstrate soft-tissue masses of intermediate signal intensity with interspersed areas of high signal intensity, as well as almost homogeneous high-signal-intensity masses that correspond to fatty areas

Soft-tissue myxomas often display characteristic MR findings, including an

intramuscular location, a surrounding rim of tissue similar to fat, and high water

content resulting in signal intensity lower than that of skeletal muscle on T1-weighted MR images and markedly high signal intensity on T2-weighted MR images (10). These features made myxoma an unlikely diagnosis in this case.

T2WI T2 STIR

The aggressive course of the clinical presentation may suggest malignant fibrous histiocytoma and sarcomas in the differential diagnosis. However, the presence of a painful mass following trauma; well-defined lesion margins; lack of infiltration in the adjacent soft tissues; and, specifically, identification of the preserved muscle fibers inside the lesion on MR images made these diagnoses less likely.

Homogeneous contrast enhancement of the intramuscular lesion on MR images enabled us to easily exclude different categories of traumatic muscle injuries, although the lesion developed after trauma. Rhabdomyolysis (Rhabdomyolysis can also be ruled out by determining levels of muscle enzymes in the blood).

Myositis ossificans is another main cause of an intramuscular soft-tissue mass. It is not an inflammatory myopathy. There is usually a history of local trauma, but it may be seen in patients with paralysis, burns, tetanus, or an intramuscular hematoma. It may also develop spontaneously (15). Several MR appearances corresponding to the

stages of maturation of myositis ossificans are noted (16,17). The area that may ossify peripherally within 6–8 weeks is swollen and painful during the 1st days or weeks of the acute phase, and it shows rim enhancement after contrast agent

injection at this early stage (17). Although the clinical features and unenhanced MR imaging findings indicated a diagnosis of myositis ossificans, the enhancement pattern enabled us to rule this out as the most likely diagnosis.

MR Imaging of Early Rheumatoid Arthritis

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