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We report a previously fit and well lady in her 50s who was referred to our tertiary center sarcoma multi-disciplinary team (MDT) after a magnetic resonance imaging (MRI) report from another center raised concern over a sarcoma in the left quadratus femoris muscle. MDT review suggested this was more in keeping with an acute muscle tear and after follow up MRI showed significant improvement in appearances, the patient was discharged with a diagnosis of a left quadratus femoris muscle injury. Quadratus femoris muscle injuries have not been widely reported in literature, and most papers describe an impingement of the muscle or tendinitis rather than a tear. This is an unusual case where an equivocal initial impression led to sarcoma MDT referral and highlights the value of clinical correlation and follow up imaging., (© 2025 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Mesenchymal chondrosarcoma (MCS) is an aggressive malignant mesenchymal tumour of uncertain differentiation. This is rare, accounting for 2%-4% of chondrosarcomas. Its peak incidence is in the second and third decades, though it can occur at any age. These tumours show a widespread distribution, mainly in bone, but with approximately 40% affecting somatic soft tissue. We present a case of MCS arising within the soleus muscle. The lesion was surrounded by a split-fat sign/fatty rind which is a typical feature of peripheral nerve sheath tumours or other benign intramuscular tumours. However, percutaneous biopsy showed MCS. We highlight how perilesional fat is not exclusive to benign intramuscular lesions and, although much less common, can be associated with malignant lesions. This is, to the best of our knowledge, the first reported case of MCS presenting with a split-fat sign at MRI., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Extraskeletal myxoid chondrosarcoma (EMC) is a malignant cartilage neoplasm usually encountered in the proximal extremities. We report the case of a 58-year-old male who presented initially with a 3-month history of cough. Initial staging demonstrated a right upper lobe mass with bilateral pulmonary nodules and moderate tracer uptake in the right lung mass and right groin on positron emission tomography imaging. Endobronchial ultrasound biopsy confirmed a histological diagnosis of EMC for which the patient underwent right upper lobe wedge resection. Pelvic MRI revealed a peripherally enhancing juxta-articular lesion within the region of the right obturator externus bursa, which was thought initially to represent either a ganglion or paralabral cyst. However, ultrasound-guided biopsy yielded identical histology to the resected lung mass leading to the diagnosis of primary EMC in the right groin with pulmonary metastases. The patient underwent surgical excision of the right groin mass with no local recurrence on the surveillance computed tomography at 5, 12, and 18 months but eventual disease recurrence in the right groin and further progression of the pulmonary metastases at 29 months. We emphasize that the contrast enhancement pattern of EMC can mimic a benign cystic lesion, in particular, when in a juxta-articular location, which has the potential to mislead radiologists and delay diagnosis and definitive treatment., (© 2023 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Objectives: The aim of this paper is to assess the acute haemorrhage rate in patients who had CT head investigation out-of-hours with and without trauma and compare the rates of haemorrhage between warfarin and DOACs, at a busy teritary teaching hospital., Methods: All CT heads performed between January 2008 and December 2019 were identified from the radiology information system (RIS) at Sheffield Teaching Hospitals (STH), with the requesting information being available from January 2015. The clinical information was assessed for the mention of trauma or anticoagulation, and the reports were categorised into acute and non-acute findings., Results: Between 2008 and 2019 the number of scans increased by 63%, with scans performed out of hours increasing by 278%. Between 2015 and 2019, the incidence of acute ICH was similar over the 5-year period, averaging at 6.9% and ranging from 6.1 to 7.6%. The rate of detection of acute haemorrhage following trauma was greater in those not anticoagulated (6.8%), compared with patients on anticoagulants such as warfarin (5.2%) or DOACs (2.8%)., Conclusions: Over 12 years, there has been a significant increase in the number of CT heads performed at STH. The rate of ICH has remained steady over the last 5 years indicating a justified increase in imaging demand. However, the incidence of ICH in patients prescribed DOACs is lower than the general population and those on warfarin., Advances in Knowledge: This finding in a large centre should prompt discussion of the risk of bleeding with DOACs in relation to CT head imaging guidelines.

Lumps in the hand are a common presenting complaint in General Practice. We present the case of a 24-year-old male who presented to his General Practitioner with a painful lump in the dorsum of his right hand. He was referred to the sarcoma services where MRI and ultrasound examinations revealed an accessory Extensor Digitorum Brevis Manus muscle as the cause of the patient's symptoms. When patients present with a painful or discomforting lump in the dorsum of the hand during or after repetitive use, typically on flexion, a diagnosis of Extensor Digitorum Brevis Manus should be considered., Competing Interests: No funding was received. The authors declare that they have no conflict of interest., (© 2020 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Deep-seated, low-grade lipomatous lesions detected on imaging often cause uncertainty for diagnosis and treatment. Confidently distinguishing lipomas from well-differentiated liposarcomas is often not possible on imaging. The approach to management of such lesions varies widely between institutions. Applying an evidenced-based approach set around published literature that clearly highlights how criteria such as lesion size, location, age and imaging features can be used to predict the risk of well-differentiated liposarcomas and subsequent de-differentiation would seem sensible. Our aim is to review the literature and produce a unified, evidence-based guideline that will be a useful tool for managing these lesions.

The InterStim II (Medtronic, Inc., Minneapolis, MN) sacral nerve stimulator has been approved for MRI scanning of the head only. All other body areas are contraindicated by the manufacturer. This report presents the successful MRI examination of the left hand in a patient with an InterStim II device. Following an assessment of the risks and benefits of proceeding with the scan it was shown that there were minimal additional risks, which could be easily managed with appropriate patient positioning, coil selection and other established techniques. Informed consent was obtained and the scan completed without incident. Following the scan the patient reported full functioning of the device. MRI of the hand is feasible in patients with InterStim II implants using transmit/receive coils with appropriate risk controls in place. Further study of the safety of MRI of other body regions in InterStim II patients is appropriate.

Objectives: Osteoid osteoma (OO) of the phalanges is regarded as a difficult diagnosis to make, both clinically and radiologically. Our aim was to assess the imaging features of this relatively rare entity to assess for consistent imaging features., Materials and Methods: Retrospective analysis of databases at our institutions was performed to identify patients with histologically confirmed OO of the phalanges. Radiographs were assessed for a nidus, surrounding sclerosis, periosteal reaction, cortical erosion and generalised soft tissue swelling. MRI scans were reviewed for visibility of the nidus; reactive marrow oedema; periostitis; and a soft tissue mass associated with the lesion., Results: Ten patients with OO occurring in a phalanx were identified. Nine out of ten patients (90%) were male. The mean age was 20 years (range 11-45). At radiography, a nidus was visible in 100% (10 out of 10) cases. Internal matrix within the nidus was seen in 60% (6 out of 10). Sclerosis surrounding the nidus was present in 90% (9 out of 10). Cortical erosion was identified in 10% (1 out of 10). Generalised swelling of the affected digit was noted in 100% (10 out of 10). Periosteal/cortical sclerosis was seen in 20% (2 out of 10). Of the 8 patients who had an MRI scan, the nidus was visible in 100% (8 out of 8). Reactive marrow oedema within the affected phalanx was present in 100% (8 out of 8). There was a soft tissue mass surrounding the affected phalanx in 75% (6 out of 8). Periosteal oedema was noted in 13% (1 out of 8)., Conclusion: Phalangeal OO demonstrates similar imaging appearances to OO at other locations in the majority of cases. An inflammatory soft tissue mass often accompanies the nidus at MRI.

Pseudomyogenic haemangioendothelioma (PMH) is a rare recently described vascular tumour typically presenting with soft tissue disease in distal extremities of young adults. Multi-focal and multi-layered involvement is commonly recognised. The majority of cases described so far have shown an indolent clinical course and distant metastatic spread is rare. We report a case of PMH in an 82-year-old male diagnosed following a pathological fracture of the distal tibia. Further bone lesions were identified in the fibula, patella and distal femur. The patient was found to have multiple nodules suspicious for pulmonary metastases on a CT scan at the time of diagnosis that showed significant progression at a follow-up scan 4 weeks later. To our knowledge, this is the first reported case of PMH presenting with a pathological fracture. The rapid progression of bone and distant metastatic disease in this case is highly unusual given the typically indolent clinical course reported in the literature to date.