Incidental finding of an undifferentiated sarcoma during lower limb Doppler ultrasound: A case report.

Introduction: Undifferentiated sarcoma is considered a rare and aggressive type of soft tissue sarcoma with the lower extremity reported as the common site for soft tissue sarcomas. Case presentation: We present a rare incidental finding of undifferentiated sarcoma during lower limb Doppler ultrasound with a presenting symptom of right thrombotic-like calf pain in a 49-year-old female. Discussion: On ultrasound, the presented undifferentiated sarcoma appeared as a large heterogeneous, oval-shaped, soft tissue mass deeply seated in the right calf with involvement of the soleus muscle. The features on ultrasound mimicked those of a hematoma; however, the possibility of the lesion being a haematoma was promptly ruled out with the demonstration of internal vascularity on colour Doppler application. The case was then referred to a sarcoma triage multidisciplinary team for a review. Magnetic resonance imaging, computed tomography and biopsy were parts of the diagnostic workup for this case, histology confirmed the soft tissue lesion to be an undifferentiated sarcoma. Emergency above knee amputation of the right leg was performed as part of the patient's treatment. Conclusion: This case report presents a rare incidental finding of undifferentiated sarcoma encountered during lower limb Doppler ultrasound causing thrombotic-like calf pain. Sonographers are encouraged to pay necessary attention and carefully examine any adjacent and incidental soft tissue lesion during lower limb Doppler ultrasound using compression, two-dimensional imaging and colour imaging, especially those that appear with characteristic features of malignancy; urgent referral should be made of such cases to a tertiary soft tissue sarcoma centre for further evaluation and management.

Peripheral nerve sheath tumour mimicking deep calf thrombus: An incidental finding during lower limb venous Doppler ultrasound.

Introduction: Peripheral nerve sheath tumours are neurogenic neoplasms that arise from the nerve sheath which are not within the central nervous system. While most of these lesions may be benign, some of them may undergo malignant transformation, establishing why it is imperative for ultrasound practitioners to familiarise themselves with ultrasound presentations of this lesion to facilitate early and effective diagnosis, which would in turn positively impact patient management. Case report: We present an incidental finding of a thrombus-mimicking peripheral nerve sheath tumour in a female patient who came to the ultrasound department for a left leg deep vein thrombosis scan. Discussion: This case study demonstrates a peripheral nerve sheath tumour which by virtue of its location (very closely adjacent the deep calf veins) and appearance (incompressible, heterogeneous, minimal colour flow), mimicked a deep calf vein thrombus on ultrasound. Careful surveillance of the area on ultrasound revealed the lesion was distinct from the calf vasculature, and further imaging was advised. A magnetic resonance imaging was conducted confirming the diagnosis of a peripheral nerve sheath tumour. Conclusion: In addition to assessing the lower limb venous system during deep venous thrombosis scans, sonographers should be mindful that other soft tissue lesions such as peripheral nerve sheath tumour may be present with symptoms that mimic those of a thrombotic leg, and therefore check to exclude or confirm the presence of any adjacent soft tissue lesions, especially at the symptomatic site indicated by the patient.