Question:

Which of the following imaging features would favor the diagnosis of soft tissue aneurysmal bone cyst (STABC) over myositis ossificans?
1. Peripherally calcified rim
2. Solid T1 isointense center
3. History of prior trauma
4. Multiple cystic spaces with thin hypointense septa
5. Progressive changes in imaging appearance with centripetal calcification pattern





Answer:

The correct answer for the question "Which of the following imaging features would favor the diagnosis of soft tissue aneurysmal bone cyst (STABC) over myositis ossificans?" is:

4. Multiple cystic spaces with thin hypointense septa



Explanation
1) Both myositis ossificans and STABC typically demonstrate peripherally calcified rims, which would not help differentiate between the two diagnoses. [STABC and myositis ossificans appear very similar on radiography and CT, as both entities feature a thin rim of ossification and a lucent/hypodense center [4,24].]
2) A solid T1 isointense center is characteristic of myositis ossificans. STABCs typically have multiple internal cystic spaces. [However, myositis ossificans will have a solid center, with T1 signal isointense to muscle and hyperintense T2 signal, whereas STABC will have a cystic center with fibrous septa and characteristic fluid-fluid levels [4,24]. ]
3) A history of prior trauma is more characteristic of myositis ossificans than of STABC. [Additionally, clinical history will often (but not always) yield an antecedent history of trauma for myositis ossificans.]
4) Multiple internal cystic spaces with thin hypointense septae is the classic imaging appearance of a STABC. [Like our case, blood filled cystic spaces produce characteristic fluid-fluid levels which can usually be appreciated on all sequences (but are best seen on more fluid sensitive sequences), and typically do not enhance following intravenous gadolinium adminstration. Septations usually have low T1 and T2 signal as a result of their fibrous (and sometimes calcified) nature and they should enhance on post-contrast images, producing a "honeycomb" type appearance if there is an extensive enough network of these septations.]
5) Myositis ossificans typically calcifies peripherally and then demonstrates centripetal calcification. [Shortly after trauma (days to 4 weeks), myositis ossificans will appear as a soft tissue mass with developing central amorphous osteoid on radiographs and CT, while formation of sharper, more mature peripheral cortical bone will start at about 4-6 weeks and mature by about 5-6 months [21].]



From the manuscript:
Soft tissue aneurysmal bone cyst: a rare case in a middle aged patient
Radiology Case. 2015 Jan; 9(1):26-35


This article belongs to the MSK section.




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From the manuscript

Soft tissue aneurysmal bone cyst: a rare case in a middle aged patient

Free full text article: Soft tissue aneurysmal bone cyst: a rare case in a middle aged patient

Abstract
Soft tissue aneurysmal bone cyst is a rare entity, with about 20 cases reported in literature, only 3 of which are in patients over 40 years of age. We present a case of a 41 year old Latin American female who presented for evaluation of atraumatic chest pain with radiation to the left shoulder. Her initial workup was negative, including radiographic imaging of the chest and left shoulder. 4 months later, she presented to her orthopedic surgeon with a palpable mass and mild left shoulder pain. Radiographs acquired at that time demonstrated a 7.0 x 5.5 x 6.7 cm mass with rim calcification in the region of the upper triceps muscle. Subsequent CT imaging showed central areas of hypodensity and thin septations, a few of which were calcified. MR evaluation showed hemorrhagic cystic spaces with multiple fluid-fluid levels and enhancing septations. Surgical biopsy was performed and pathology was preliminarily interpreted as cystic myositis ossificans, however on final review the diagnosis of soft tissue aneurysmal bone cyst was made. The lesion was then surgically excised and no evidence of recurrence was seen on a 3 year post-op radiograph. Following description of our case, we conduct a literature review of the imaging characteristics, diagnosis, and treatment of soft tissue aneurysmal bone cyst.






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