Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2020 May 21;15(7):1091-1094.
doi: 10.1016/j.radcr.2020.05.006. eCollection 2020 Jul.

MR imaging findings in perineal nodular induration ("cyclist´s nodule"): A case report

Andrea De Cima  1 , Nuria Pérez  2 , Gerardo Ayala  1
Affiliations
Case Reports

MR imaging findings in perineal nodular induration ("cyclist´s nodule"): A case report

Andrea De Cima et al. Radiol Case Rep. .

Abstract

Perineal nodular induration (PNI) is a rare condition related to sports linked to the use of a saddle, mostly cycling, thought to be caused by the compression of the soft tissue between the saddle and the ischial tuberosity. We report a case of a 59-year-old amateur cyclist male who presented with 2 bilateral nodular perineal lesions that were evaluated with ultrasound and magnetic resonance imaging (MRI). MRI findings, along with the history of a strong cycling habit, led to the diagnosis of PNI, and a conservative management was adopted. MRI features of PNI are characteristic, and may provide the diagnosis in the proper clinical setting.

Keywords: Cyclist’s nodule; MRI; Perineal nodular induration; Third testicle; US.

PubMed Disclaimer

Figures

Fig 1
Fig. 1
Axial US image (A) and Doppler examination (B) show two predominantly hyperechogenic superficial lesions (arrows) with no increased vascularity.
Fig 2
Fig. 2
Axial (A), coronal (B) and sagittal (C) fast spin-echo T2 weighted images; Axial (D) fat suppressed T2 weighted image. MRI shows two ill-defined subcutaneous perineal lesions (arrows), with low to intermediate signal intensity on T2WI and slight hyperintensity on F-S T2WI. Note the symmetric nodular formations protruding from the perineum, also known as “accessory testicles” (open arrow in B).
Fig 3
Fig. 3
Axial diffusion-weighted image (b-value of 800 s/mm2) (A) and corresponding ADC map (B), show low signal intensity lesions on DWI with high ADC value, findings consistent with no restricted diffusion.
Fig 4
Fig. 4
Axial gadolinium-enhanced fat suppressed T1-weighted GE images obtained at 30 seconds (A) and 5 minutes delay (B) show a subtle diffuse enhancement that becomes more conspicuous on the late phase.
See this image and copyright information in PMC

References

    1. Stoneham A., Thway K., Messiou C., Smith M. Cyclist´s nodule: no smooth ride. BMJ Case Rep. 2016;2016(March) - PMC - PubMed
    1. Devers KG., Heckman SR., Muller C., Joste NE. Perineal nodular induration: a trauma-induced mass in a female equestrian. Int J Gynecol. 2010;29(July (4)):398–401. - PubMed
    1. McCluggage WG., Smith JH. Reactive fibroblastic and myofibroblastic proliferation of the vulva (cyclist's nodule): a hitherto poorly described vulvar lesion occurring in cyclist. Am J Surg Pathol. 2011;35(January (1)):110–114. - PubMed
    1. Alakeel A., Halabi-Tawil M., Besseige H., Crickx B., Descamps V. Biker's Nodule: A perineal nodular induration of the cyclist. Adv Sexual Med. 2012;2:1–2.
    1. González-Pérez R., Carneroa L., Arbide N., Soloeta R. Perineal nodular induration in cyclist. Actas Dermosifiliogr. 2009;100(December (10)):919–920. - PubMed

Publication types

LinkOut - more resources