Superficial Fibular Nerve Sheath Tumor

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Superficial Fibular Nerve Sheath Tumor

Authors, Editors, Case Information Author: Jack Kilgore, MD Affiliation: Vanderbilt University Medical Center, Department of PM&R Co Author(s): Stephen Schaaf, MD Senior Editor: Adam Lewno, DO Clinical Vignette: 77-year-old cyclist presented with acute right lower leg and ankle pain with an associated soft tissue mass just proximal to the lateral malleolus. The symptoms began gradually, without trauma, a few weeks prior to presentation. Exam of the right ankle was notable for pain with direct palpation over the area with radiating pain and numbness into the lateral ankle and foot. There was no weakness or skin changes. A right ankle x-ray demonstrated no osseous abnormalities. Type of Probe Used: 13-5 MHz Linear Array Transducer Unlabeled Short Axis View of the Superfician Peroneal Nerve Sheath Lesion Unlabeled Short Axis View of the Superfician Peroneal Nerve Sheath Lesion Labeled Short Axis View of the Superfician Peroneal Nerve Sheath Lesion Labeled Short Axis View of the Superfician Peroneal Nerve Sheath Lesion. Note the hypoechoic, ovoid mass which appears to be continuous with the nerve Unlabeled Long Axis View of the Superfician Peroneal Nerve Sheath Lesion Unlabeled Long Axis View of the Superfician Peroneal Nerve Sheath Lesion Labeled Long Axis View of the Superfician Peroneal Nerve Sheath Lesion Labeled Long Axis View of the Superfician Peroneal Nerve Sheath Lesion #5 - Video View Video Short Axis Cine of the the Superfician Peroneal Nerve Sheath Lesion from proximal to distal. The muscle belly to the left of the fibula is the peroneus longus and the muscle belly to the right of the fibula underneath the peripheral nerve sheath tumor is the extensor digitorum longus. #6 - Video View Video Long Axis Cine of the Superficial Peroneal Nerve Sheath Lesion from medial to lateral, the extensor digitorum longus muscle is underneath the peripheral nerve sheath tumor and then the tibia is the hyperechoic bony structure deep to the muscle. Interpretation Image Interpretation: There is a hypoechoic echogenic ovoid mass measuring approximately 1.1 cm in width by 0.5 cm in thickness by approximately 2.4 cm in length that appeared to be arising and continuous with the distal portion of the superficial fibular nerve. The mass was non compressible, had no significant vascular flow on color Doppler, and had posterior acoustic enhancement. There was tenderness on sonopalpation. Teaching Pearl: Ultrasound can be helpful in evaluating many superficial soft tissue masses because it can assess echotexture, vascularity, compressibility, and real-time correlation with symptoms. A peripheral nerve sheath tumor should be suspected when a fusiform hypoechoic mass is continuous with a nerve entering and exiting the lesion. An important point is to prove whether a mass is nerve-related before attempting aspiration or injection. Progressive neurologic deficit, rapid growth, marked vascularity, or atypical features should prompt MRI with contrast and specialty referral. References: 1. Jacobson JA, Middleton WD, Allison SJ, et al. Ultrasonography of superficial soft-tissue masses: Society of Radiologists in Ultrasound consensus conference statement. Radiology. 2022;304(1):18-30. doi:10.1148/radiol.211101 2. Griffith JF. Practical approach to ultrasound of soft tissue tumors and the added value of MRI: how I do it. J Ultrason. 2023;23(95):e299-e312. doi:10.15557/JoU.2023.0036 3. Lefebvre G, Le Corroller T. Ultrasound and MR imaging of peripheral nerve tumors: the state of the art. Skeletal Radiol. 2023;52(3):405-419. doi:10.1007/s00256-022-04087-5
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Authors, Editors, Case Information

Unlabeled Short Axis View of the Superfician Peroneal Nerve Sheath Lesion

Labeled Short Axis View of the Superfician Peroneal Nerve Sheath Lesion

Unlabeled Long Axis View of the Superfician Peroneal Nerve Sheath Lesion

Labeled Long Axis View of the Superfician Peroneal Nerve Sheath Lesion

#5 - Video

#6 - Video

Interpretation

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