Post-traumatic painful thigh mass in a 5-year-old child revealing rhabdomyosarcoma with vascular encasement and biopsy-tract seeding: A diagnostic pitfall.
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Rhabdomyosarcoma is the most common soft-tissue sarcoma in children. Its clinical presentation may be misleading, particularly when it develops after minor trauma, mimicking benign post-traumatic conditions such as hematoma. Diagnostic delay may occur if radiological warning signs are overlooked. We report the case of a 5-year-old child presenting with a rapidly enlarging painful thigh mass following minor trauma. Initial clinical suspicion favored a post-traumatic hematoma. Multimodal imaging, including ultrasound, plain radiography, and magnetic resonance imaging (MRI), revealed findings inconsistent with a benign lesion. MRI demonstrated a large intramuscular mass with diffusion restriction, heterogeneous enhancement, intralesional necrosis, femoral vascular encasement with distal revascularization, and tumor seeding along the biopsy tract. Histopathological examination confirmed rhabdomyosarcoma. This case highlights a common yet critical diagnostic pitfall in pediatric musculoskeletal imaging. Rapid growth, solid components, diffusion restriction, vascular encasement, and biopsy-tract seeding should raise suspicion for malignancy, even in the setting of recent trauma.