Neurofibromatosis Type 1 - McGovern Medical School at UTHealth
Neurofibromatosis Type 1
Megan Mont 9/18/2019 Diagnostic Radiology: RAD 4001 Nicholas M. Beckmann, MD
Clinical History
15-year-old male initially seeing PCP for left leg pain while playing soccer. Patient has long standing history of a skin nodule along the posterior left thigh. No other pertinent medical history. Mother has history of neurofibromatosis type 1.
McGovern Medical School
Lytic lesion with surrounding sclerosis
femur
femur patella
tibia fibula
fibula
tibia
McGovern Medical School
Vastus medialis
Sartorius Mixed high and low T2
signal
femur
Vastus lateralis
Vastus intermedius
Quadriceps tendon
femur
patella
Biceps femoris
meniscus
T2
Patellar tendon
tibia
Extensor digitorum longus
T2
McGovern Medical School
PCL Soleus
tibia
Popliteus
Gastrocnemius
Vastus medialis Popliteal artery and vein
Sartorius
Gracilis
Femur (with lesion)
Vastus lateralis
Enhancing skin nodule
Semimembranosus Tibial nerve (with lesion)
Biceps femoris (long head)
Common peroneal nerve (with lesion)
PD
T1 post-contrast
McGovern Medical School
Femoral artery and vein Vastus medialis
Sartorius Adductor longus
Gracilis
Rectus femoris Femur
Vastus lateralis
Vastus intermedius
Enhancing intermuscular
nodule
Semimembranosus
Sciatic nerve Adductor magnus
Semitendinosus
Biceps femoris (short head)
Biceps femoris (long head)
PD
T1 post-contrast
McGovern Medical School
Tibialis posterior
Tibia Tibialis anterior
Extensor hallucis longus
Tibial nerve (with lesion)
Flexor hallucis longus
Extensor digitorum longus Fibula Tibialis anterior artery and vein
Peroneal artery and vein
Sural nerve
PD (with lesion)
Peroneus longus et brevis
McGovern Medical School
Key Imaging Findings
? Lytic lesion in the distal femur metadiaphysis
? X-ray: septations, sclerotic rim ? MRI: Lobulated margins and mixed high and very low T2 signal
? Skin nodule in the posterior distal thigh
? MRI: high signal on proton density images with diffuse avid enhancement
? Hamstring, tibial nerve, and peroneal nerve nodules
? MRI: increased PD signal and avid enhancement
McGovern Medical School
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