We describe a 65-years-old male patient, who came to our department with an asymptomatic mass in the right axilla. On clinical history, the patient reported a previous surgical intervention in the same site, two years before, for lipoma excision.
On US, a well defined mass, localised deeply in the right axillary subcutaneous tissue, just above the axillary vein, measuring 4 x 3 cm, was detected.
Subsequently CE-MR was performed. On MR the lesion appeared as a well defined mass with heterogeneous signal on T2- weighted image, and isointense on T1-weighted image. On fat suppressed T2 weighted image, the mass had heterogenous signal with multiple low signal intensity portions. After gadolinium administration, we observed a heterogeneous enhancement, with low signal central areas suggestive of necrosis. Core biopsy was not performed because of the lesion’s location, so the patient underwent excisional biopsy. At pathology, a central zone of fibrinoid necrosis and fat necrosis surrounded by vessels and proliferating fibroblasts was detected. Macroscopically the lesion was ill-defined, tan-white, elastic and non- ulcerated. Therefore diagnosis of ischaemic fasciitis was established.
Ischaemic fasciitis is caused by fibroblasts/myofibroblasts proliferation set in a myxoid stroma. This condition usually occurs in aged, debilitated, bed-ridded patients or after trauma [1]. It is considered as a reactive process, which occurs in the areas of pressure over the bones.
The pathogenesis seems to include intermittent ischaemia, an association with local mechanical pressure or trauma cannot be found in all cases [2-3].
CLINICAL PERSPECTIVE
Common findings are a poorly-circumscribed, non ulcerated, hard elastic, asymptomatic mass, localised deeply in subcutaneous tissues, which often involve muscles, tendons and fascia. According to its rapid growth, it could be misinterpreted as a sarcoma or other malignant soft tissue tumour [5].
IMAGING PERSPECTIVE
On US, a mass with hyperechoic rim surrounding an hypoechoic central area can be depicted.
On MRI, it appears as an isointense mass on T1 sequence, with low signal central area and a high signal intensity rim on T2w sequences. After contrast agent administration it usually shows a heterogeneous signal [5, 6].
CASE MANAGEMENT
Core biopsy was not performed because of lesion’s position immediately above main axillary vessels.
Patient underwent surgery with associated lymphectomy.
Histological analysis confirmed the clinical diagnosis.
Fasciitis with the characteristics of ischaemic type.
Based on the provided MRI images (transverse, sagittal, and coronal views), the following findings are observed:
Considering the patient's age, previous surgical history in the right axillary region, current MRI findings, and pathological results, the following differential diagnoses can be taken into account:
Taking into account the patient’s age, clinical history (including previous surgery in the same area), imaging findings, and final histopathological results, the diagnosis is:
Ischemic Fasciitis (Ischaemic Fasciitis).
In cases suspected of soft tissue tumor, tissue biopsy or postsurgical pathology is usually required for definitive diagnosis. In this case, due to the lesion’s close proximity to major vessels, no needle biopsy was performed; the final diagnosis was confirmed through pathology after surgical resection.
Given that this condition is often associated with local ischemia, repeated pressure, or trauma, the goals of rehabilitation are to:
This report is a reference analysis based on the available imaging, patient history, and pathological findings. It does not replace an in-person consultation or professional medical opinion. If you have any questions or notice changes in your symptoms, please seek medical attention for further evaluation and treatment.
Fasciitis with the characteristics of ischaemic type.
