decubital ischemic fasciitis is a rare entity occurring mostly in the elderly and in debilitated patients , in the deep subcutaneous tissue , at pressure points or bony prominences.[14 ] it can simulate a soft - tissue sarcoma clinically and histopathologically.[14 ] imaging helps to rule out malignancies and therefore to prevent unnecessary interventions .
a 72-year - old woman presented with a palpable mass over the right hip region .
physical examination revealed a 4- to 5-cm , hard , and fixated mass in the right proximal thigh , located posterolateral to the greater trochanter .
mri revealed diffuse hyperintense signals on the t2w images [ figures 1a and 1b ] consistent with edema and inflammation , in the muscles and subcutaneous tissues , with prominent , peripheral , and ill - defined enhancement [ figure 2 ] , over an area measuring approximately 4 - 7 cm , at the level of the greater trochanter .
a ct - guided needle biopsy showed coagulative necrosis , hemorrhage , and fibrosis involving the adipose tissue .
the capillary and muscular vessels within the lesion also showed fibrinoid necrosis in their walls , without evidence of primary vasculitis [ figure 3 ] .
these findings , along with the clinical features , were considered compatible with the diagnosis of ischemic fasciitis ( atypical decubital fibroplasia ) .
axial ( a ) and coronal ( b ) fat - suppressed t2w images show diffuse hyperintense signals ( arrows ) in the muscles and subcutaneous tissues , adjacent to the right greater trochanter axial contrast - enhanced t1w , fat - suppressed mri shows subtle , peripheral enhancement ( arrow ) in an area measuring approximately 47 cm , at the level of the greater trochanter histopathologic slide ( h and e stain ) shows coagulative necrosis and hemorrhage with capillary and muscular vessels showing fibrinoid necrosis in their walls ( arrows )
decubital ischemic fasciitis , also called atypical decubital fibroplasia , is a distinctive fibroplasia occurring predominantly in the elderly and debilitated patients , confined to bed or wheelchair - bound.[13 ] the lesions occur in the deep subcutaneous tissue at pressure points or bony prominences .
it is a rare condition , and 40 cases have been reported in the literature until 2009 .
ilaslan et al . have reported the mri features of decubital ischemic fasciitis in three patients . on mri ,
the mass - like area in our patient was isointense compared to muscle on the t1w images , and hyperintense on the t2w images .
after administration of gadolinium , subtle and peripheral enhancement was seen in the subcutaneous and muscular tissues .
the bone adjacent to the affected soft tissue ( greater trochanter ) was not involved .
lesions occurring in the shoulder , sacral area , posterior chest wall , and vulvovagina have been reported .
the diagnosis of decubital ischemic fasciitis with typical findings on mri prevents the already debilitated patient from undergoing further and unnecessary interventions .
consideration of this entity by the clinician and the radiologist helps the pathologist rule out malignancy .
we want to point out that since mri is a common and appropriate imaging method used to examine soft - tissue masses , all radiologists , especially those evaluating musculoskeletal mri examinations , should be aware of this entity and be familiar with the clinical features , common locations , and mri findings .
 the mri findings in a case of decubital ischemic fasciitis located posterolateral to the right greater trochanter , in a 72-year - old woman , are presented . 
 decubital ischemic fasciitis is an uncommon entity encountered mostly in debilitated , elderly patients , in the deep subcutaneous tissue , at pressure points or bony prominences . 
 it can simulate soft - tissue sarcomas . 
 recognition of this lesion radiologically is important to prevent unnecessary interventions . 
Introduction
Case Report
Discussion