article · Radiology Case Reports
Post-traumatic liponecrotic granuloma is a non-cancerous soft-tissue lesion caused by the breakdown of fatty tissue following blunt injury. While fat necrosis is common, large encapsulated lesions resembling tumours are rare and can easily be mistaken for malignant soft-tissue neoplasms. In an illustrative clinical case, a forty-year-old woman developed a massive, painless gluteal mass measuring over twelve centimetres across five years after a road accident. Comprehensive assessment combining ultrasound, computed tomography, and magnetic resonance imaging allowed clinicians to identify specific structural hallmarks, including internal calcifications, a thin capsule, central fat content, and an absence of abnormal blood flow or post-contrast enhancement. Correlating past physical trauma with multimodality diagnostic imaging provides clinicians with the confidence to identify benign lesions non-invasively, reducing the need for unnecessary surgical interventions or invasive biopsies.
Distinguishing harmless post-injury masses from aggressive soft-tissue cancers presents a serious clinical hurdle. Demonstrating how standard imaging tools can definitively characterise these benign growths protects patients from distressing misdiagnoses. It also guides medical teams to avoid risky, expensive, and unnecessary surgical biopsies, ultimately improving clinical decision-making and patient care pathways following traumatic injuries.
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Post-traumatic liponecrotic granuloma is a benign soft-tissue lesion resulting from adipose tissue necrosis after blunt trauma. Although post-traumatic fat necrosis is a recognized entity, large encapsulated lesions with a pseudotumoral appearance are rare and may closely mimic soft-tissue neoplasms, creating a diagnostic challenge. In this setting, multimodality imaging is essential for accurate lesion characterization and appropriate patient management. We report the case of a 40-year-old woman presenting with a progressively enlarging left gluteal mass that developed over 5 years following a road traffic accident. Clinical examination revealed a well-defined, firm, painless mass without overlying inflammatory skin changes. Ultrasound demonstrated a large avascular subcutaneous lesion measuring 122 × 109 × 89 mm (craniocaudal × anteroposterior × transverse). Computed tomography showed a well-circumscribed lobulated fat-containing mass with internal calcifications. Magnetic resonance imaging demonstrated a well-defined lobulated subcutaneous lesion with a thin hypointense capsule enclosing a central fatty component that was hyperintense on T1- and T2-weighted images, completely suppressed on fat-saturated sequences, and showed no significant postcontrast enhancement. The combination of a history of trauma and characteristic multimodality imaging findings strongly supported the presumptive diagnosis of post-traumatic liponecrotic granuloma. This case highlights the importance of correlating clinical history with ultrasound, computed tomography, and magnetic resonance imaging to accurately characterize chronic post-traumatic soft-tissue lesions. It also illustrates the diagnostic challenge posed by large encapsulated fat necrosis with a pseudotumoral appearance and emphasizes the value of multimodality imaging in establishing a confident presumptive diagnosis while potentially avoiding unnecessary invasive procedures.
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DOI: 10.1016/j.radcr.2026.07.070
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