0:00

Just continuing on with some more hip cases

0:03

that I found interesting, uh, and hopefully y'all will too.

0:07

And, uh, so wrapping up, uh, the sort of tumor

0:11

and tumor like lesions.

0:13

This next case is, uh, adult with, uh,

0:16

left anterior lateral hip mass who presented

0:19

to our orthopedic oncology clinic.

0:22

And as we can see here on these, uh, anatomic sequences,

0:27

uh, axial small field of view, we see that, uh,

0:31

the patient denoted the palpable abnormality of the mass

0:34

of concern by the overlying fiduciary marker at the anter

0:37

lateral aspect of the hip.

0:39

Immediately adjacent to this, we see that the, uh,

0:42

tensor fascia, lata muscle is, uh, abnormally enlarged.

0:47

It's, uh, partly fatty replaced.

0:50

Um, and unfortunately, uh, we did not get a large field

0:54

of view sequence on this side.

0:57

Maybe we can hallucinate possibly portions of it

1:01

and, uh, of the tensor fascia latte,

1:04

but even, uh, sort of looking on our localizers.

1:08

And I highly recommend, and I harp on my trainees

1:11

or our trainees here to look at our localizers.

1:14

'cause sometimes a larger for of view image, uh,

1:17

although poor, poor quality gradients, what have you, uh,

1:20

can still offer some, uh, diagnostic information.

1:23

And, and this single coronal image, we got quite,

1:27

we got a little bit lucky.

1:28

We can see, we can appreciate the slightly larger, uh, uh,

1:32

enlarge, uh, slight asymmetric enlargement

1:34

of the left tensor fascia Lata on this side.

1:37

So just conning, going back down to our cone down images

1:41

or our small field of view images.

1:42

This is just a, a nice cute case

1:45

of a benign do not touch lesion

1:48

or a, uh, diagnosis of pseudo hypertrophy

1:52

of the tensor phos.

1:53

Lot of muscle. We see this every once in a while.

1:56

It'll come in as a, you know,

1:58

palpable abnormality sort of thing.

1:59

Perhaps, uh, someone just recently lost weight and

2:03

or they bumped themselves and they just feel this bump now.

2:06

But, uh, this is basically, um, well first of all,

2:09

before we, um,

2:11

before I get into pseudo hypertrophy, make sure to, uh,

2:15

when dealing with, uh, muscles

2:16

or muscle bumps, make sure, uh, that we're, uh,

2:20

to differentiate whether you're dealing with

2:22

a hypertrophy muscle or a pseudo hypertrophy muscle.

2:26

Obviously with a hyper, truly hypertrophy muscle, the volume

2:30

of the muscle is going to be increased,

2:32

but, uh, the muscle fibers will be intact.

2:35

Um, along those lines every once in a while too, you can get

2:39

a, uh, muscle herniation.

2:41

Okay. Perhaps this, uh, a patient's had, uh,

2:44

previous injury, but muscle herniations more commonly are

2:47

gonna, um, at sites of perforating vessels.

2:50

Loves, loves, loves to involve the lower leg,

2:54

and that is at the level of the tibial fibula,

2:55

particularly the anterior tibialis, uh, muscle,

2:58

What have you. But in

2:59

theory could happen here, perhaps

3:01

after, I don't know, a procedure of the hip.

3:05

Okay? So that's something to also keep on differential,

3:08

but this turned out to be pseudo hypertrophy

3:11

of the tensor fascia.

3:13

And so the tensor fascia, uh, I learned on anatomic studies.

3:19

It's actually a quite complex

3:21

or, uh, uh, uh, interesting muscle as, uh, Dr.

3:24

Patria, uh, talked about earlier in her, uh, hip talk.

3:29

But, uh, basically anatomic studies have shown

3:31

that this muscle is typically about, I don't know, 150

3:35

millimeters in length, cranial coly to about 20

3:38

to 30 millimeters in, uh, in, uh, thickness in the, at, uh,

3:43

sorry, the ap, uh, diameter.

3:46

And there are a couple of, uh, theories

3:48

to why the muscle pseudo hypertrophies.

3:51

One is obviously, uh, you know,

3:53

hopefully the patients don't have an underlying muscular

3:56

dystrophy or a like, uh, um, to explain that,

4:00

that pseudo hypertrophy.

4:02

But, uh, other things are chronic injury, um, overuse.

4:07

Uh, but that would lead more to hypertrophy failure of, uh,

4:11

nearby agonist muscles, particularly the gluteus minimus

4:14

and medias, uh, tendons that in theory could, uh,

4:18

one would expect that to lead more to hypertrophy

4:20

of the muscle rather than pseudo hypertrophy.

4:23

Right. And then, uh, lastly, you can get pseudo hypertrophy,

4:27

uh, occasionally, uh, written in the literature

4:30

by our neurosurgery colleagues, uh,

4:33

because, uh, as the lumbosacral plexus,

4:37

particularly the L five nerve root, uh, is dinged

4:41

that can get to, uh, nerve denervation changes.

4:45

And with that, you can get abnormal fatty fatty deposition

4:48

and connective tissue deposition with the, uh,

4:51

nerve changes and what have you.

4:53

Okay. Um, the tensor fasciitis for those that, uh,

4:57

are into neuroimaging or,

4:58

or neurography, uh, it is, uh, innervated, uh,

5:02

and correct me if I'm wrong, by the superior gluteal nerve,

5:05

which takes, uh, posterior nerve roots off of the, uh,

5:09

L four through S one nerve roots.

5:12

So any of those, uh, potentially nerves if involved, uh,

5:15

more centrally at the lumbosacral spine could in theory lead

5:19

to this diagnosis of TFL

5:21

or tensor fasci lata pseudo hypertrophy.

5:24

So something to think about so

5:25

that you don't misdiagnose it, um,

5:28

and, uh, uh, get the patient

5:30

or work up the patient further for unnecessary imaging

5:33

or potentially procedures.