This case provides some food for thought when assessing patients who have palpable steps in their soft tissues following direct trauma.
This patient in his late 20's had fallen off his bike six weeks earlier, but had continued to complain of a swelling over the lateral aspect of his thigh. The area which impacted the ground when he fell. Although he did report that this had improved steadily over the past six weeks. He was subsequently referred to the Radiology department for an ultrasound of the area. As this patient was seen within Radiology, there was not time for a full clinical exam, that might be performed within an MSK outpatient setting.
The images below demonstrate the sequence of images that were obtained from the lateral aspect of thigh. These indicate a fat rupture (also know occasionally as a 'fat fracture') within the subcutaneous fat layers of the thigh. This can mimick a muscle tear, by having a palpable step in the soft tissues.
A useful article on 'fat rupture' can be found in this paper by Thomas et al (2001)
We hope you have found some useful learning points from this article, please continue to share with colleagues.
Further musculoskeletal ultrasound case studies can be found here.
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