Findings, case of 55-year-old man, painful left thigh mass

Imaging Findings

Axial CT images (soft tissue and bone windows) show a large, hypodense lesion involving multiple muscle groups. Some calcification is evident. Sclerosis and periosteal reaction extend to the knee joint. It seems that there is some resorption of trabeculae in the distal femur.

STIR images show a multilobulated, T2-hyperintense lesion with diffuse medullary edema of the distal femur. No cortical breakdown is apparent on MR. Pre- and post-contrast MR images show diffuse enhancement of the lesion. Displacement of normal fat in the marrow is visible, as is some enhancement of the marrow. Areas of necrosis cross the muscle plane.

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