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Adventitious bursitis of the plantar forefoot may mimic a solid tumoral mass at MRI to some extent. However, key findings may allow for a correct diagnosis: location in a plantar area submitted to high weight-bearing pressure, context of professional overload of the plantar forefoot, and rapid decrease in size of the mass with relative discharge of the forefoot or cessation of overloading activities. Knowledge of the possible partial solid appearance of adventitious bursitis and heterogeneous signal intensity on T2-weighted MR sequences is helpful to avoid unnecessary biopsy. However, a biopsy of the mass is still needed if the mass does not decrease in size with rest within the following weeks.






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From the manuscript

Adventitious bursitis in the plantar fat pad of forefoot presenting as a tumoral mass

Free full text article: Adventitious bursitis in the plantar fat pad of forefoot presenting as a tumoral mass

Abstract
Adventitious bursitis of the plantar fat pad is a common cause of forefoot pain. It may develop at sites where subcutaneous tissue is exposed to friction and high pressure. In the forefoot, adventitious bursitis is usually adjacent to bony prominences of the metatarsal heads. Diagnosis and management of adventitious bursitis usually do not require imaging studies. However, the condition occasionally presents as a solid pseudotumoral mass requiring imaging. Magnetic resonance imaging (MRI) may demonstrate a heterogeneous mass with a solid component exhibiting intermediate to high signal intensity on T2-weighted images and thick nodular enhancement suggesting a neoplastic lesion. We report three cases of adventitious bursitis in patients who complained of a painful palpable mass on the forefoot, with a partially solid and enhancing component seen on MRI. In the first case, a biopsy was performed for the diagnosis of adventitious bursitis. The two other cases exhibited a solid component on MRI. However, a diagnosis of adventitious bursitis was suspected, and it was felt that a biopsy could be postponed. The spontaneous regression of the mass with relative discharge of the forefoot pressure confirmed the diagnosis. With these three cases, we illustrate the MR findings that could suggest adventitious bursitis despite the presence of a solid component and that may obviate the need for pathologic proof.






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