(Left) Coronal graphic shows the normal course of the femoral nerve relative to the psoas muscle and inguinal ligament . The femoral nerve produces multiple peripheral branches to the anterior thigh muscles.
(Right) Coronal STIR MR (femoral neuropathy postsurgical herniorrhaphy) depicts marked enlargement, T2 hyperintensity of the right femoral nerve , with abrupt transition at the right groin. In this case, the femoral nerve was accidentally ligated during herniorrhaphy.
(Left) Axial STIR MR (femoral neuropathy postsurgical herniorrhaphy) through the pelvis confirms that the right femoral nerve in the iliopsoas groove is markedly enlarged with discrete T2 hyperintense fascicles (compared to the normal left femoral nerve ).
(Right) Axial CECT (severe hemophilia) depicts large left iliacus and psoas hematomas. Femoral neuropathy occurs from compression of the adjacent femoral nerve, which runs along the psoas muscle and iliopsoas groove.
TERMINOLOGY
Synonyms
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Femoral mononeuropathy, femoral nerve (FN) palsy
Definitions
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FN entrapment or injury 2° to direct trauma, compression, stretch injury, or ischemia
IMAGING
General Features
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Best diagnostic clue
Femoral nerve enlargement, abnormal T2 hyperintensity
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Location
Injury most common at psoas muscle body, iliopsoas groove, or femoral canal
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Morphology
Nerve enlargement ± loss of internal fascicular architecture, abnormal T2 hyperintensity
CT Findings
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CECT
± retroperitoneal/psoas mass, hematoma, lymphadenopathy
MR Findings
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T1WI
Isointense → hypointense nerve enlargement ± retroperitoneal/psoas mass
± hyperintense quadriceps muscle (fatty atrophy 2° to chronic denervation)
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T2WI
Hyperintense nerve (± fascicular) enlargement
± abnormal quadriceps muscle T2 hyperintensity (acute/ongoing denervation)
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STIR
Similar to fat-saturated T2WI