PMC4901154_01
56-year-old man with Phaeoacremonium parasiticum myositis. Axial CT of the left thigh with intravenous contrast. A. In the soft tissues of the lateral thigh, a 5.6 x 4.4 x 1.5-centimeter rim-enhancing abscess tracking appears between the iliotibial band and the underlying anterior compartment musculature (arrows). B. Note the deep extension into the underlying vastus lateralis (arrowheads).
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At that time, a CT scan showed a 6 x 4 x 2 enhancing abscess cavity in the left anterior thigh with extension to deep structures (Fig. 1).
56-year-old man with Phaeoacremonium parasiticum myositis. Intraoperative sonogram of the left thigh. Ellipsoid fluid collection with hyperechoic debris appears in the lateral thigh. Within the fluid collection, a linear hyperechoic foreign body measuring about 0.5 x 0.2 x 0.1 cm (cross mark) appears.
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At that time, a small foreign body was removed (Fig. 2).
56-year-old man with Phaeoacremonium parasiticum myositis. MRI of the left thigh with IV contrast obtained 3 months after the surgical drainage. A. Axial T1-weighted MRI shows a nodular lesion of intermediate signal intensity (long white arrows) within the substance of the vastus lateralis muscle. B. Fat-suppressed T2-weighted MRI shows hyperintensity within the lesion, and there is a surrounding rim of low signal intensity (short white arrows) that presumably represents infected granulation tissue. C. Axial fat-suppressed T1-weighted MRI following intravenous gadolinium-based contrast injection shows a nodular, somewhat serpinginous, focus of enhancement within the vastus lateralis muscle (arrowheads). There is enhancing edema in the surrounding vastus lateralis muscle. There is no rim-enhancing abscess. D. Sagittal STIR MRI shows superficial and deep extension of the lesion, but the remaining muscles of the anterior compartment and the bone marrow are normal in signal.
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Followup MRIs were performed at 3, 6, and 9 months after the initiation of posaconazole treatment (Figure 3, Figure 4).
56-year-old man with Phaeoacremonium parasiticum myositis. Followup MRI of the left thigh with IV contrast 9 months after the surgical drainage. A. Axial fat-suppressed T2-weighted MRI shows hyperintensity lesion with surrounding edema in the vastus lateralis muscle that is decreased in size and intensity. There is a persistent low-signal-intensity rim (arrows). B. Axial fat-suppressed T1-weighted MRI following intravenous gadolinium-based contrast injection shows small conglomerated enhancing lesion that is decreased in size. C. Sagittal STIR MRI shows resolved extension into the deep tissue.
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Followup MRIs were performed at 3, 6, and 9 months after the initiation of posaconazole treatment (Figure 3, Figure 4).