Medical Imaging Analysis Report

1. Imaging Findings

Based on the provided X-ray, ultrasound, and MRI images, the following major characteristics can be observed:

• X-ray Findings: Multiple soft tissue masses visible on the dorsum of the foot, toes, and parts of the lower leg. Their boundaries may appear lobulated or mass-like. No obvious destructive changes to the bone were noted, although local thinning or slight compression of the cortical bone can be observed around the foot region (metatarsophalangeal joints, near the toes). Bone density shows no significant abnormalities or extensive destructive changes.
• Ultrasound Findings: Multiple irregularly shaped soft tissue masses with predominantly hypoechoic or mixed echoes, showing abundant blood flow signals, indicating a vascular-rich lesion. Inside the lesions, lobulated or small sinus-like changes can be seen in some areas, and certain segments show a marked increase in blood flow.
• MRI Findings: Multiple lobulated or mass-like soft tissue lesions are seen on the dorsum of the foot, between the toes, and extending into parts of the lower leg. These lesions exhibit high signal intensity on T2-weighted images and iso- or slightly low signal on T1-weighted images. After contrast administration, there is significant enhancement. The lesions may extend upward along the subcutaneous tissue and some intermuscular spaces, characterized by relatively clear boundaries but with an invasive tendency.

2. Potential Diagnoses

Considering the patient’s clinical symptoms (slow progression, soft tissue swelling in the foot and lower leg) and imaging findings (multiple vascular-rich, mass-like soft tissue lesions), the main differential diagnoses include:

1. Fungal Infection (especially chronic foot skin lesions): Certain fungal infections can lead to chronic thickening or nodular lesions, but they typically involve primarily skin damage. Imaging findings usually do not show such pronounced vascular proliferation, and lesions often present with local skin ulceration or other signs of infection.
2. Bacterial Hemangioma-like Lesion (such as Bacillary Angiomatosis related to Bartonella): In immunocompromised individuals, vascular proliferative lesions may appear as multiple nodules, with imaging also showing prominent enhancement. However, these typically come with systemic symptoms or a notable clinical background.
3. Kaposi's Sarcoma: Associated with HHV-8, commonly seen in immunocompromised individuals but can also occur in those with relatively intact immune function. Clinically, it often presents as violaceous skin plaques or nodules that can spread through the subcutaneous tissue. On imaging, it may appear as soft tissue hemangioma-like or vascular proliferative lesions with significant enhancement on contrast scans.

3. Final Diagnosis

As this patient’s biopsy has confirmed the lesion to be Kaposi’s Sarcoma, and in light of the clinical presentation and typical imaging features (multiple lobulated soft tissue lesions, abundant blood flow, significant enhancement), the most likely final diagnosis is:

Kaposi’s Sarcoma.

If further clarification of the extent of the lesions or overall systemic evaluation is needed, relevant laboratory tests (including HIV testing, immune function assessment, etc.) and imaging studies of other regions are recommended.

4. Treatment Plan and Rehabilitation

Based on the characteristics of Kaposi’s Sarcoma and the potential associated immunologic status, the following treatment strategies can be considered:

• Pharmacological Treatment: For patients with compromised immune status or those at risk for systemic disease, chemotherapy, interferon therapy, or antiviral treatments targeting HHV-8 may be considered (if the patient is HIV-positive, concurrent antiretroviral therapy is recommended).
• Local Therapy: For localized or superficial lesions, options include local radiation therapy or surgical excision. Smaller lesions can also be treated with laser or cryotherapy to alleviate local symptoms.
• Systemic Supportive Treatment: In cases of underlying immunodeficiency (e.g., HIV infection), targeted antiretroviral therapy and immune reconstitution measures should be implemented.

Rehabilitation/Exercise Prescription Suggestions

Since the lesions mainly involve the foot and lower leg soft tissues, it is important to balance maintaining stability in the affected area with performing functional exercises. Prolonged inactivity could lead to decreased muscle strength or limited joint mobility. Below is a stepwise, individualized example:

1. Early Stage (postoperative or early treatment phase):
   • Focus on protection and reducing irritation to painful areas. If there is a wound or local radiation therapy site, avoid excessive weight-bearing.
   • Conduct gentle active range-of-motion exercises for the ankle and toe joints (such as ankle circles, small flexion-extension movements), 5–10 minutes per session, 2–3 times a day.
   • If there is significant local pain, use cold therapy or other pain management strategies as needed.
2. Intermediate Stage:
   • Once local lesions stabilize, gradually increase joint mobility and muscle strengthening exercises. Examples include toe towel-grabs, calf raises (with support while balancing against a wall or using assistive devices).
   • Increase training frequency to 3–4 times per day, 10–15 minutes per session, while closely monitoring pain or discomfort.
3. Late Stage (functional enhancement):
   • When lesions are well-controlled and pain is minimal, consider moderate aerobic exercises such as walking on flat ground or using a stationary bike, 20–30 minutes per session, 3–5 times per week.
   • Gradually introduce light resistance exercises, such as ankle resistance work with elastic bands or light dumbbell exercises for lower limbs, under the guidance of a rehabilitation professional.

Throughout the rehabilitation process, warming up before exercise and proper cool-down afterward should be emphasized. High-impact or intense jumping exercises should be avoided. If there are concerns like bone fragility, improper footwear, or restricted joint mobility, adjustments should be made under the guidance of a rehabilitation or sports medicine specialist.

Disclaimer

This report is based solely on the provided medical history and imaging data for reference purposes and does not substitute for an in-person consultation or professional medical advice. If you have any questions or if your condition changes, please seek medical attention promptly and follow the guidance of a specialist.