Abstract
Musculoskeletal pseudotumors on imaging are not a rarity and may be increasingly detected due to an increased use of diagnostic imaging and expanding subspecialized clinical referral basis. A large variety of pseudotumors exist. Although there have been technical advances and there is a diversity of imaging modalities, the diagnosis of a pseudotumor remains challenging and its morphologic features may be difficult to distinguish from those of a malignant neoplastic lesion. It requires a systematic approach with awareness of the common types of pseudotumors, its imaging appearances, regional anatomy, injury mechanisms, and carefully obtained clinical history. This chapter illustrates the most important pseudotumors on imaging, their imaging characteristics on different imaging modalities, and possible clinical settings with keys to differential diagnosis. Emphasis is placed on MRI.
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References
Abdelwahab IF, Klein MJ, Hermann G (2003) Solitary cysticercosis of the biceps brachii in a vegetarian: a rare and unusual pseudotumor. Skelet Radiol 32:424–428
Ahlawat S, Wadhwa V, Belzberg AJ, Batra K, Chhabra A (2015) Spectrum of suprascapular nerve lesions: normal and abnormal neuromuscular imaging appearances on 3-T MR neurography. AJR Am J Roentgenol 204:589–601
Anderson SE, Johnston JO, ODonnel R et al (2001) MR imaging of Sports related pseudotumor in Children: mid femoral diaphyseal periostitis at insertion site of adductor musculature. AJR Am J Roentgenol 176:1227–1231
Anderson SE, Bosshard C, Steinbach LS et al (2003a) Calcification of the lateral collateral ligament of the knee: a rare pathology and cause of lateral knee pain shown by MR imaging. AJR Am J Roentgenol 181(1):199–202
Anderson SE, De Monaco D, Buechler U et al (2003b) Imaging Features of Pseudoaneurysms of the Hand in Children and Adults. AJR Am J Roentgenol 180:659–664
Anderson SE, Steinbach LS, De Monaco D et al (2004a) The baby wrist: MRI of an overuse syndrome of mothers. AJR Am J Roentgenol 182:719–724
Anderson SE, Weber M, Steinbach LS et al (2004b) Shoe rim and shoe buckle pseudotumor of the ankle in elite and professional ice figure skaters and snow boarders: MR imaging findings. Skelet Radiol 33:325–329
Baum T, Yap SP, Dieckmeyer M et al (2015) Assessment of whole spine vertebral bone marrow fat using chemical shift-encoding based water-fat MRI. J Magn Res Imag 42:1018–1023
Behrens SB, Deren ME, Matson A, Fadale PD, Monchik KO (2013) Stress fractures of the pelvis and legs in athletes: a review. Sports Health 5:165–174
Bianchi S, Becciolini M (2019) Ultrasound appearance of the migration of tendon calcifications. J Ultrasound Med 38:2493–2506
Biviji AA, Paiement GD, Steinbach LS (2002) Musculoskeletal manifestations of the human immunodeficiency virus infection. J Am Acad Orthop Surg 10:312–320
Boutin RD, Fritz RC, Steinbach LS (2002) MRI of muscle injury. Radiol Clin N Am 40:333–362
Breer S, Krause M, Marshall RP, Oheim R, Amling M, Barvencik F (2012) Stress fractures in elderly patients. Int Orthop 36:2581–2587
Brown S-AN, Doolittle DA, Bohanon CJ et al (2015) Quadrilateral space syndrome: the mayo clinic experience with a new classification system and case series. Mayo Clin Proc 90:382–394
Capelastegui A, Astigarraga E, Fernandez-Canton G et al (1999) Masses and pseudomasses of the hand and wrist: MR findings in 134 cases. Skelet Radiol 28:498–507
Conn J Jr, Bergan JJ, Bell J (1970) Hypothenar hammer syndrome: posttraumatic digital ischaemia. Surgery 68:1122–1128
Connell DA, Schneider-Kolsky ME, Hoving JL et al (2004) Longitudinal study comparing sonographic and MRI assessments of acute and healing hamstring injuries. AJR Am J Roentgenol 183:975–984
Coyle J, White LM, Dickson B, Ferguson P, Wunder J, Naraghi A (2013) MRI characteristics of nodular fasciitis of the musculoskeletal system. Skelet Radiol 42:975–982
De Coninck T, Vanhoenacker F, Verstraete K (2017) Imaging features of Morel-Lavallée lesions. J Belg Soc Radiol 101(Suppl 2):15. https://doi.org/10.5334/jbr-btr.1401
De Smet AA, Noris MA, Fisher DR (1992) Magnetic resonance imaging of myositis ossificans: analysis of seven cases. Skelet Radiol 21:503–507
Desimpel J, Posadzy M, Vanhoenacker F (2017) Imaging features of symptomatic hypertrophic tuberculum peroneum. J Belg Soc Radiol 101(Suppl 2):7. https://doi.org/10.5334/jbr-btr.1376
Dhondt E, Oudenhoven L, Khan S et al (2006) Nora’s lesion, a distinct radiological entity? Skelet Radiol 35:497–502
Dong PR, Seeger LL, Yao L et al (1995) Uncomplicated cat-scratch disease: findings at CT, MR imaging, and radiography. Radiology 195:837–839
Dooms GC, Fisher MR, Hricak H et al (1985) MR imaging of intra-muscular hemorrhage. J Comput Assist Tomogr 9:908–913
Dorfman HD, Czerniak B (1998) Benign osteoblastic tumors. In: Bone tumors. 1st ed. Mosby, St Louis, MO, pp 85–127
Ekstrand J, Askling C, Magnusson H, Mithoefer K (2013) Return to play after thigh muscle injury in elite football players: implementation and validation of the Munich muscle injury classification. Br J Sports Med 47:769–774
Fonseca E, Castro A, Kubo RS, Miranda FC, Taneja AK, Santos D, Rosemberg LA (2019) Musculoskeletal “don’t touch” lesions: pictorial essay. Radiol Bras 52(1):48–53
Fujimoto H, Ikeda M, Shimofusa R et al (2002) Sarcoidosis breaching the fascia and mimicking a sarcoma. Skelet Radiol 31:706–708
Furman J (2015) When exercise causes exertional rhabdomyolysis. J Am Acad Phys Assist 28:38–43
Gardiner GA Jr, Tan A (2017) Repetitive blunt trauma and arterial injury in the hand. Cardiovasc Intervent Radiol 40:1659–1668
Glichenstein J, Ohana J, Leclercq C (1988) Tumors of the hand. Springer, Berlin, pp 147–150
Gomori JM, Grossman RI, Golberg HI et al (1985) High field magnetic resonance imaging of intracranial hematomas. Radiology 157:87–93
Greenspan A, Azouz EM (1999) Bone dysplasia series. Melorheostosis: review and update. Can Assoc Radiol J 50:32
Gruber G, Giessauf C, Leithner A et al (2008) Bizarre parosteal osteochondromatous proliferation (Nora lesion): a report of 3 cases and a review of the literature. Can J Surg 51:486–489
Hardcastle P, Annear P, Foster DH et al (1992) Spinal abnormalities in young fast bowlers. J Bone Joint Surg (Br) 74-B:421–425
Janevski BK (1979) Angiography of the upper extremity. In: Greep JN et al (eds) Pain in the shoulder and arm. Nijhoff M, The Hague-Boston-London, pp 25–48
Jarraya M, Parva P, Stone M, Klein MJ, Guermazi A (2014) Atypical proliferative myositis: original MR description with pathologic correlation: case report. Skelet Radiol 43:1155–1159
Jelinek J, Kransdorf MJ (1995) MR imaging of soft-tissue masses. Mass-like lesions that simulate neoplasms. Magn Reson Imaging Clin N Am 4:727–741
Kalbermatten DF, Kabermatten NT, Hertel R (2001) Cotton-induced pseudotumor of the femur. Skelet Radiol 30:415–417
Karantanas A (2019) Imaging of motion and performance, sports overuse and injury. Muscle Injuries Chapter 3(2):35
Kransdorf M, Murphey M (1997) Masses that may mimic soft tissue tumors. In: Kransdorf M (ed) Imaging of soft tissue tumors. WB Saunders Company, Philadelphia, pp 373–420
Kwee RM, Kwee TC (2019) Calcified or ossified benign soft tissue lesions that may simulate malignancy. Skelet Radiol 48:1875–1890
Little JM, Ferguson DA (1972) The incidence of hypothenar hammer syndrome. Arch Surg 105:684–685
Mahajan S, Chandra R, Mohan LY (2012) “Nora lesion”—Bizarre parosteal osteochondromatous proliferation. J Clin Orthopaed Trauma 3(2):119–121. https://doi.org/10.1016/j.jcot.2012.07.001
Maurer B, Walker UA (2015) Role of MRI in diagnosis and management of idiopathic inflammatory myopathies. Curr Rheumatol Rep 17:67–67
McLean K, Popovic S (2017) Morel-Lavallee lesion: airp best cases in radiologic-pathologic correlation. Radiographics 37:190–196
Min B-W, Song K-S, Cho C-H, Lee S-M, Lee K-J (2008) Untreated asymptomatic hips in patients with osteonecrosis of the femoral head. Clin Orthop Relat Res 466:1087–1092
Mueller-Wohlfahrt HW, Haensel L, Mithoefer K et al (2013) Terminology and classification of muscle injuries in sport: the Munich consensus statement. Br J Sports Med 47(6):342–350. https://doi.org/10.1136/bjsports-2012-091448
Newmeyer W (1993) Vascular disorders. In: Green D (ed) Operative hand surgery, 3rd edn. Churchill Livingstone, New York, pp 2251–2299
Nöbauer-Huhmann (2019) Imaging of motion and performance. Bone Tumours Chapter 24:231
Ogilvie CM, Kasten P, Rovinsky D et al (2001) Cysticercosis of the triceps—an unusual pseudotumor. Clin Orthop Relat Res 382:217–221
Pavlov H (1995) Physical injuries: sports related abnormalities. In: Resnick D (ed) Diagnosis of bone and joint disorders, 3rd edn. WB Saunders, Philadelphia, pp 3229–3263
Perdikakis E, Tsifountoudis I, Kalaitzoglou I, Rountas C, Malliaropoulos N, Maffulli N (2017) Soft tissue pseudotumours: a pictorial review with emphasis on MRI. Muscles Ligaments Tendons J 7:353–375
Pereira BPG, Chang EY, Resnick DL, Pathria MN (2016) Intramuscular migration of calcium hydroxyapatite crystal deposits involving the rotator cuff tendons of the shoulder: report of 11 patients. Skelet Radiol 45:97–103
Ragunanthan N, Sugavanam C (2006) Pseudomalignant myositis ossificans mimicking osteosarcoma: a case report. J Orthop Surg (Hong Kong) 14:219–221
Rani D, Gupta A (2019) Cytological diagnosis and misdiagnosis of nodular fasciitis. J Cytol 36:196–199
Richardson ML, Zink-Brody GC, Patten RM et al (1996) MR characterization of post-irradiation soft tissue edema. Skelet Radiol 25:537–543
Robinson P, White LM, Lax M, Salonen D, Bell RS (2000) Quadrilateral space syndrome caused by glenoid labral cyst. AJR Am J Roentgenol 175:1103–1105
Rubin JI, Gomori JM, Grossman RI et al (1987) High-field MR imaging of extracranial hematomas. AJR Am J Roentgenol 148:813–817
Sakata R, Fujioka H, Tomatsuri M et al (2015) Treatment and diagnosis of Panner’s disease. A report of three cases. Kobe J Med Sci 61:E36–E39
Sanders BS, Bruce J, Robertson J (2011) Treatment of a symptomatic forearm muscle herniation with a mesh graft. Sports Health 3:179–181
Schneider R, Kaye JJ, Ghelman B (1976) Adductor avulsive injuries near the symphysis pubis. Radiology 120:567–569
Shimal A, Davies AM, James SL, Grimer RJ (2010) Fatigue-type stress fractures of the lower limb associated with fibrous cortical defects/non-ossifying fibromas in the skeletally immature. Clin Radiol 65:382–386
Soler R, Castro JM, Rodriguez E (1996) Value of MR findings in predicting the nature of soft tissue lesions: benign, malignant or undetermined lesion? Comput Med Imaging Graph 20:163–169
Soler R, Rodriguez E, Aguilera C et al (2000) Magnetic resonance imaging of pyomyositis in 43 cases. Eur J Radiol 35:59–64
Squire T, Sherlock M, Wilson P, Tan B, Hope N, Anderson SE (2010) Surfinoma: a case report on a pseudotumor developing after a surfing sports injury. Skelet Radiol 39:1239–1243
Steinbach LS, Johnston JO, Tepper EF et al (1995) Tumoral calcinosis: radiologic-pathologic correlation. Skelet Radiol 24:573–578
Stensby JD, Baker JC, Fox MG (2016) Athletic injuries of the lateral abdominal wall: review of anatomy and MR imaging appearance. Skelet Radiol 45:155–162
Sutter R, Kalberer F, Binkert CA, Graf N, Pfirrmann CWA, Gutzeit A (2013) Abductor tendon tears are associated with hypertrophy of the tensor fasciae latae muscle. Skelet Radiol 42:627–633
Thierfelder KM, Gerhardt JS, Gemescu IN et al (2019) Imaging of hip and thigh muscle injury: a pictorial review. Insights Imaging 10:20. https://doi.org/10.1186/s13244-019-0702-1
Torreggiani WC, Munk PL, Al-Ismail K et al (2001) MR imaging features of bizarre parosteal osteochondromatous proliferation of bone (Nora’s lesion). Eur J Radiol 40:224–231
Tsai TS, Evans HA, Donnelly LF et al (1997) Fat necrosis after trauma: a benign cause of palpable lumps in children. AJR Am J Roentgenol 169:1623–1626
Van Hul E, Vanhoenacker F, Van Dyck P, De Schepper A, Parizel PM (2011) Pseudotumoural soft tissue lesions of the foot and ankle: a pictorial review. Insight Imaging 2:439–452
Wadhwa V, Cho G, Moore D, Pezeshk P, Coyner K, Chhabra A (2016) T2 black lesions on routine knee MRI: differential considerations. Eur Radiol 26:2387–2399
Walczak BE, Johnson CN, Howe BM (2015) Myositis Ossificans. J Am Acad Orthop Surg 23:612–622
Wang H, Nie P, Li Y et al (2018) MRI findings of early myositis ossificans without calcification or ossification. Biomed Res Int 2018:4186324
Wilmot AS, Ruutiainen AT, Bakhru PT, Schweitzer ME, Shabshin N (2016) Subchondral insufficiency fracture of the knee: a recognizable associated soft tissue edema pattern and a similar distribution among men and women. Eur J Radiol 85:2096–2103
Yoshioka H, Anno I, Niitsu M et al (1994) MRI of muscle strain injuries. J Comput Assist Tomogr 18:454–460
Zubler V, Muhlemann M, Sutter R et al (2020) Diagnostic utility of perilesional muscle edema in myositis ossificans. Skelet Radiol 49(6):929–936. https://doi.org/10.1007/s00256-019-03351-5
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Lunkiewicz, M., Davies, A.M., Anderson, S.E. (2021). Pseudotumors in Sports. In: Vanhoenacker, F.M., Maas, M., Gielen, J.L. (eds) Imaging of Orthopedic Sports Injuries. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2020_270
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