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Granuloma Annulare

Case Detail

Anatomy: Musculoskeletal
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Infectious-Inflammatory
Created: over 7 years ago
Updated: over 7 years ago
Tags: PEDS
Modality/Study Types: CR MR CT NM
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History

7 year old female with enlarging pretibial soft tissue mass.


Case Images


Diagnosis

Granuloma Annulare

Clinical Notes

History of right nephrectomy for Wilms tumor; favorable histology, peritoneal spill at time of surgery.

Findings

CR – Uniform density pretibial soft tissue mass without calcification or osseous destruction.

MR – Infiltrative and enhancing T1 hypointense, T2 hyperintense subcutaneous lesion with broad based contiguity with the fascia. Normal hematopoietic marrow.

PET-CT – Variably hypermetabolic region corresponding to palpable abnormality. Otherwise normal biodistribution of F-18 fluorodeoxyglucose.

Discussion

Granuloma annulare is an uncommon, benign group of dermatoses. Subcutaneous granuloma annulare occur most frequently in healthy young children as a painless, nonmobile mass usually found in a lower extremity. Occasionally granuloma annulare may present with pain, rapid enlargement, or unusual location. The differential diagnosis includes posttraumatic, infectious, neoplastic, and syndromic or systemic disease-associated categories.

On MR, granuloma annulare is isointense on T1, hyperintense on T2 and variably enhancing relative to muscle and have instinct margins. Granuloma annulare is hypermetabolic on fluorodeoxyglucose PET and isodense to muscle on conventional radiography and CT.

Reference

Chung S, et al. Subcutaneous granuloma annulare:MR imaging findings in six children and literature review. Radiology 1999; 210:845-849.

Dadban A, et al. Widespread granuloma annulare and Hodgkin’s disease. Clinical and Experimental Dermatology 2008; 33(4):465-468.

Yoshida SM and Yamamoto O. Granuloma annulare detected by positron emission tomography with computed tomography in a diffuse large B cell lymphoma. Eur J Dermatol 2009; 19(2):174-175.



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