Differential diagnosis of a large soft tissue swelling is multiple, but perhaps the most feared diagnosis is a soft tissue sarcoma. Inappropriate aspiration may cause seeding of the cancer cells and complicates future management of the soft tissue sarcoma.
This is a case of a 44 year old male, with a one month history of left thigh swelling. There was no fever, pain, discharge and no trauma. On examination, there was a large swelling over antero medial aspect of the thigh. A junior doctor suspected underlying abscess and attempted needle aspiration but it was a dry aspirate. Bedside ultrasound showed a well enscapsulated dense lesion, rather homogenous in appearance. The diagnosis of possible benign soft tissue tumour was made. But because of it’s its significant size, soft tissue sarcoma has to be ruled out, hence the patient was referred to orthopaedic oncology unit. MRI scan confirms this finding of homogenous lesion suggestive of intramuscular lipoma.
DISCUSSION & CONCLUSION
Point of care ultrasound is a useful adjunct to narrow down differential diagnosis of a swelling and fast track patient to the appropriate unit.