Case Study:

A 24-year-old man was referred to a surgeon with a suspected intramuscular lipoma in his right upper thigh. On examination, a prominent lump was visible in the upper medial portion of the right thigh and a soft mass could be palpated. Distal to the mass, the surgeon noted a shallow triangular defect apparently in the musculature lateral to the gracilis muscle and medial to the sartorius muscle. When the patient adducted the leg against resistance, the mass became more round and firm.

Computed tomography (CT) indicated that the mass was muscular and not adipose, as initially suspected. Upon questioning, the patient indicated that he had sustained an injury to the medial thigh about 1 year earlier. He had been kicking a soccer ball with the medial aspect of his foot at the same time that an opponent was attempting to kick the ball in the opposite direction. He had felt a sharp pain immediately, but after several days, the pain subsided, so he thought he had strained a muscle.

He did not become concerned until the mass had started to grow in his right thigh. A needle biopsy showed that the mass was normal muscle tissue, and since the patient experienced no discomfort, the surgeon told him that no treatment was required.

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Questions:

1. What do you think that the mass was?

2. What do you suspect happened to cause the mass in the first place, and why was it growing?

3. How can a radiologist differentiate between muscle tissue and adipose tissue on a CT scan?

4. What was the defect the surgeon noticed below the mass?

5. What other things might present as a swelling in the medial thigh?




Answers:


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