PMC4899984_01
68-year-old male with decubital ischemic fasciitis. A. Sonography of the right calf region using 12-MHZ linear probe shows hypoechoic lobulated mass in the subcutaneous plane. B. Color Doppler examination shows relative avascularity of the lesion.
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An ultrasound examination of that region showed a lobulated, hypoechoic subcutaneous lesion with multiple echogenic nodules (Fig. 1A). There was no significant vascularity within the lesion on Doppler examination (Fig. 1B).
68-year-old male with decubital ischemic fasciitis. A. Axial T1W image shows mass lesion in the subcutaneous plane, indenting the lateral gastrocnemius, that was isointense to muscle (TR = 440, TE = 8.2). B. Axial STIR shows hyperintense signal of the mass lesion (TR = 3260, TE = 55.1).
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The lesion caused smooth indentation over the adjacent lateral head of the gastrocnemius muscle (Figure 2, Figure 3).
68-year-old male with decubital ischemic fasciitis. A. Sagittal T2W image shows mild hyperintense signal of the mass lesion (TR = 5220, TE = 113). B. Post-contrast, sagittal, T1-weighted, fat-suppressed image shows the heterogeneously enhancing mass lesion [TR = 600, TE = 7.7].
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The lesion caused smooth indentation over the adjacent lateral head of the gastrocnemius muscle (Figure 2, Figure 3).
68-year-old male with decubital ischemic fasciitis. A. Skin with ulceration and extensive ischemic changes involving dermis and subcutaneous tissue. >H&E stain x40. B. Viable areas in the dermis show bizarre fibroblasts with enlarged pleomorphic nuclei. Note the maintenance of nuclear cytoplasmic ratio, favoring a reactive non-neoplastic lesion. H&E stain x200.
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Microscopic examination showed a lobulated myxoid lesion with extensive pleomorphism of fibroblasts and endothelial cells in skin and the subcutaneous plane (Fig. 4).