Fig. 4

Detection of metastatic lymphadenopathy through short-term USG in a 69-year-old female with undifferentiated pleomorphic sarcoma. (a,b,c) Axial T2-, T1-, and enhanced T1-weighted images revealed infiltrative heterogeneous signal intensity mass with enhancement primarily located in the subcutaneous layer of the right anterolateral ankle. Focal invasion with cortical erosion at the distal fibula was noted (arrows). Additionally, the mass exhibited tail-like enhancement along the investing fascia (dashed arrows). (d) The patient underwent wide excision of the tumor with fibular resection and tibiotalar fusion. (e) On her postoperative USG, 21 months after wide resection, a small but suspicious-looking lymph node was incidentally observed in the right inguinal area. Loss of hilar echogenicity and infiltrative growth of the tumor outside the original lymph node contour were observed (arrowheads). (f) Color Doppler USG revealed peripheral vascularity. The lymph node was excised and confirmed as a metastatic lymph node