Nodular Fasciitis in the Head and Neck: CT and MR Imaging Findings
Sung Tae Kima,c,
Hyung-Jin Kima,c,
Sun-Won Parkc,
Jung Hwan Baekb,
Hong Sik Byuna and
Young Mo Kimd
a Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
b Department of Otolaryngology and Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
c Department of Radiology, Inha University College of Medicine, Incheon, Korea
d Department of Otorhinolaryngology, Inha University College of Medicine, Incheon, Korea
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FIG 1. Case 2. Nodular fasciitis on the left lateral malar area in an 18-year-old man. Contrast-enhanced axial CT scan shows a well-defined ovoid soft tissue mass in the subcutaneous fat just beneath the zygomaticus major muscle (arrow). Note marked, though heterogeneous, enhancement of the lesion.
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FIG 2. Case 3. Nodular fasciitis involving the right perinasal area in a 14-month-old boy.
Contrast-enhanced axial CT scan (A) and axial T1-weighted (B), T2-weighted (C), and contrast-enhanced T1-weighted (D) MR images show a well-defined, relatively thick-walled, round cystic mass in the subcutaneous fat just beneath the levator labii superioris muscle. Arrow in C indicates the same muscle in the contralateral cheek. Compared with CSF, the cystic portion of the lesion demonstrated slightly hyperintense signal intensity on T1-weighted image (B) and isointense signal intensity on T2-weighted image (C). Note peripheral rimlike enhancement of the lesion. The absence of imaging findings of associated infection, such as perilesional infiltration, edema, or enhancement does not favor the diagnosis of abscess.
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FIG 3. Case 5. Nodular fasciitis in the left supraclavicular fossa in an 11-year-old girl.
Contrast-enhanced axial CT scan (A) and coronal T1-weighted (B), T2-weighted (C), and contrast-enhanced fat-suppressed T1-weighted (D) MR images show a markedly enhancing, well-defined, ovoid soft tissue mass in the subcutaneous fat of the left supraclavicular fossa. The lesion has a partly serrated border on contrast-enhanced MR image (D). Compared with the adjacent muscle, the mass is isointense and significantly hyperintense on T1- (B) and T2-weighted (C) images, respectively.
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FIG 4. Case 7. Nodular fasciitis deeply seated in the right periorbital area in a 16-month-old boy.
Contrast-enhanced coronal CT scan (A) and coronal T1-weighted (B), coronal fat-suppressed T2-weighted (C), and coronal and axial contrast-enhanced fat-suppressed T1-weighted (D and E) MR images show a large, ill-defined, mixed solid and cystic mass deep to the temporalis muscle. The mass causes massive erosion of the adjacent bony orbit and skull. The signal intensity of the solid portion of the lesion was isointense to that of muscle on both T1- (B) and T2-weighted (C) images, whereas its cystic portion was slightly hyperintense and isointense to that of CSF on T1- (B) and T2-weighted (C) images, respectively. The mass also contains presumed hemorrhagic or highly proteinaceous components seen as high signal intensity on T1-weighted image (B). Note marked, peripheral, irregular, and nodular enhancement of the lesion.
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