79-year-old female with right proximal anterolateral thigh pain and history of neurofibromatosis, assess known proximal femur mass for progression in size and character and concern for hematoma per outside hospital report Please note that exam is limited due to patient motion artifact and contrast-enhanced portions were not completed due to patient pain.Again seen is a mass within the anterior compartment of the thigh extending from the anterior aspect of the hip joint along the anterior femur over a length of approximately 16 cm. The mass is associated with chronic erosions along the anterior aspect of the femoral neck as well as the anterior femoral diaphysis at the level of the lesser trochanter. Although the erosion is similar in size, the lesion has increased in size measuring approximately 9.5 x 7 cm in cross section. On T1 weighted images, the lesion is largely isointense to skeletal muscle but contains poorly defined hyperintense signal. On T2 weighted images, the lesion is heterogeneous with foci of high signal intensity as well as signal voids. This pattern of signal intensity is compatible with the clinical suspicion of hematoma. Edema is present within the musculature and fascial planes surrounding the mass extending down the thigh to the level of an old fracture of the distal femoral diaphysis. Additional edema is noted within the subcutaneous fat along the lateral aspect of the hip. The rectus femoris muscle and tendon is displaced anteriorly by the mass and contains a smaller neurofibroma, similar to the prior exam. The remainder of the quadriceps musculature is not well-defined. The femoral artery and vein is displaced medially. Additional smaller neurofibromas are noted within the thigh. On large field of view images, additional neurofibromas are seen involving the right thigh. A scar traversing the subcutaneous fat along the right buttock presumably reflects the site of resection of known malignant peripheral nerve sheath tumor. Heterogeneous marrow is seen bilaterally, which presumably represents reconverted red marrow.
Enlargement of mass along the anterior aspect of the femur with a signal intensity pattern in keeping with hematoma. Please note that we cannot exclude malignancy.