Retrospective evaluation of patients with clinically suspected superficial palmar or plantar fibromatosis.
Patient sample was obtained through systematic search of the radiology department database from our institution.
Several patients with clinically suspected superficial fibromatoses performed ultrasound and/or MRI for diagnostic confirmation.
Case 1 - Plantar fibromatosis in a 19 year-old male
Patient complained of a nodular tumefaction on the sole of the left foot.
Ultrasonography revealed a fusiform,
hypoechoic,
heterogenous thickening of the subcutaneous tissue superficial to the proximal insertion of the plantar fascia.
The plantar fascia was not thickened.
The nodule did not show evidence of vascularity.
Fig. 1: Case 1
MRI was performed to characterise the lesion,
which was located in the subdermal region and showed hypo-intensity on T1WI and T2WI,
albeit heterogenous on DP fat-saturation sequences,
which was consistent with an area of plantar fibromatosis.
Post-gadolinium study revealed slight peripheral enhancement (not shown).
Fig. 2: Case 1
Fig. 3: Case 1
Case 2 - Palmar fibromatosis in 45 year old male
Patient with multiple palmar fibromatosis at the first,
second,
third and forth metacarpo-phalangeal MCP joints.
Several hypoechoic nodules abut the corresponding flexor tendons,
although no structural changes are seen.
Fig. 4: Case 2
Fig. 5: Case 2
Case 3 - Bilateral plantar fibromatosis in a 61 year-old male
Patient was referred for MRI of the foot,
with a documented ultrasound mentioning "fascial nodules in both feet".
The plantar fascia was focally thickened at the distal segment,
with several small nodules discernible within the lesion.
They were heterogenous,
although mostly hypointense on all sequences.
There was evidence of heterogenous enhancement after post-gadolinium administration.
Fig. 6: Case 3
Fig. 7: Case 3
Fig. 8: Case 3
Case 4 - Plantar fibromatosis in a 56 year-old male
Patient with complaints of pain on the sole of the foot when walking performed ultrasound,
which revealed a hypoechoic nodule adjacent to the superficial fascia.
MRI revealed a small nodule on the mid-foot,
in contact with the superficial fascia and hypointense on every sequence,
consistent with plantar fibromatosis.
Fig. 9: Case 4
Fig. 10: Case 4
Case 5 - Fibro-inflammatory tissue after heel spur surgery in a 45-year old female
MRI of the hind-foot was performed on a patient who previously had surgery for heel spur.
Subdermal fibrosis extending from the superficial layers to the plantar fascia is seen on T1WI.
This tissue is hypo-intense on all sequences and does not show enhancement after gadolinium administration.
The plantar fascia is widely thickened (maximum diameter 10 mm),
with heterogeneity at the proximal insertion and bone marrow edema.
These findings are compatible with plantar fasciitis.
Fig. 11: Case 5
Case 6 - Multiple plantar fibromatosis in a 45 year-old female
Ultrasound performed on patient with multiple plantar nodules revealed typical features of plantar fibromatosis on several locations of the mid-foot,
some of them embedding the superficial fascia and in close contact with the plantar musculature.
Fig. 12: Case 6
Case 7 - Post-carpal tunnel syndrome surgery fibrosis in 73 year-old female
Patient had been previously subjected to Carpal Tunnel Syndrome surgery nad was referred for intense pain on pressure on the wrist joint.
Evaluation of the tissue below the surgical scar by ultrasound revealed a hypoechoic,
heterogenous area coursing adjacent to the median nerve.
These findings were sugestive post-surgical fibrosis.
There was no contracture or functional abnormality of the flexor tendons.
Fig. 13: Case 7