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Research ArticleHEAD AND NECK

Nodular Fasciitis in the Head and Neck: CT and MR Imaging Findings

Sung Tae Kim, Hyung-Jin Kim, Sun-Won Park, Jung Hwan Baek, Hong Sik Byun and Young Mo Kim
American Journal of Neuroradiology November 2005, 26 (10) 2617-2623;
Sung Tae Kim
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Hyung-Jin Kim
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Sun-Won Park
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Jung Hwan Baek
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Hong Sik Byun
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Young Mo Kim
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  • Fig 1.
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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.

Tables

  • Figures
  • Clinical and imaging findings in 7 patients with nodular fasciitis in the head and neck

    Patient No./Age/SexChief ComplaintPhysical ExaminationTrauma HistoryCT ScanMR ImageLocationSize* (cm)ShapeContentSignal Intensity on MR ImagingEnhancement Pattern
    T1WIT2WI
    1/48 y/FRecurrent preauricular mass for 3 moRubbery hard, nontender, movableYesYesNoPeriparotid subcutaneous tissue1.0Round, ill definedSolid——Mild heterogeneous enhancement
    2/18 y/FRapidly growing cheek mass for 3 moRubbery hard, nontender, movableNoYesNoLateral malar area beneath zygomaticus major muscle1.8Ovoid, well definedSolid——Marked heterogeneous enhancement
    3/14 mo/MPerinasal mass for 1 mo with no significant growthRubbery hard, nontender, movableNoYesYesPerinasal area beneath levator labii superioris muscle2.0Round, well definedCompletely cysticCystic portion slightly hyperintenseHyperintensePeripheral rim enhancement
    4/35 y/MCheek mass for 1 mo with no significant growthRubbery hard, nontender, movableNoNoYesLateral malar area beneath zygomaticus major muscle1.5Ovoid, well definedSolidIsointenseHyperintenseModerate homogeneous enhancement
    5/11 y/FRapidly growing supraclavicular mass for 3 moRubbery hard, nontender, movableNoYesYesSubcutaneous tissue of supraclavicular fossa3.5Ovoid, well definedSolidIsointenseHyperintenseMarked homogeneous enhancement
    6/22 y/FRapidly growing scalp mass for 1 moRubbery hard, tender, movableNoYesNoSubcutaneous tissue of occipital scalp1.3Oblong, well definedSolid——Marked homogeneous enhancement
    7/16 mo/MRapidly growing periorbital mass for 2 moRubbery hard, nontender, fixedYesYesYesPeriorbital area deep to temporalis muscle4.6Ovoid, ill definedPartly cysticSolid portion isointense, cystic portion slightly hyperintenseIsointensePeripheral nodular enhancement
    • * Size in greatest diameter.

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American Journal of Neuroradiology: 26 (10)
American Journal of Neuroradiology
Vol. 26, Issue 10
1 Nov 2005
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Nodular Fasciitis in the Head and Neck: CT and MR Imaging Findings
Sung Tae Kim, Hyung-Jin Kim, Sun-Won Park, Jung Hwan Baek, Hong Sik Byun, Young Mo Kim
American Journal of Neuroradiology Nov 2005, 26 (10) 2617-2623;

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Nodular Fasciitis in the Head and Neck: CT and MR Imaging Findings
Sung Tae Kim, Hyung-Jin Kim, Sun-Won Park, Jung Hwan Baek, Hong Sik Byun, Young Mo Kim
American Journal of Neuroradiology Nov 2005, 26 (10) 2617-2623;
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