Extremity Non-Vascular and Soft Tissue Masses

Powerpoint

Why is ultrasound useful for superficial soft-tissue lesions

It provides high-resolution real-time imaging and allows direct correlation with the palpable abnormality, patient history, compression, movement, and Doppler findings

What the initial assessment when scanning soft-tissue masses

determine whether mass is superficial (cutaneous/subcutaneous) or deep to the subcutaneous tissue

What clinical date should be obtained before a scan

When the mass was first noticed, whether it has changed in size, history of trauma or surgery, and whether there is pain or drainage

What transducer should be used for soft tissue scan

high-frequency linear transducer

Why should you use abundant gel while scanning palpable superficial lesion

to reduce pressure needed while scanning the lesion to improve evaluation

How should superficial soft-tissue lesion be scanned/measured

scan in 2 planes with 3 measurements

What anatomic relationships should be documented for a soft-tissue mass

Its relationship to the dermis and nearby nerves, blood vessels, tendons, muscles, and bone

How can muscle contraction help during a soft-tissue exam

It can help identify lesions that arise from or move with muscle

How can the Valsalva help when evaluating an abdominal wall mass

It can distinguish the mass from a hernia

What can doppler evaluation help with

It can aid in diagnosis of the lesion by distinguishing solid, vascular, inflammatory, and fluid-containing lesions

What is recommended when a soft-tissue mass is not clearly benign/has suspicious features

interval follow-up ultrasound, contrast-enhanced MRI, biopsy, or surgical consultation

Most common soft tissue tumor and is it benign/malignant

lipoma, it is benign with no malignant portential

Lipoma clinical presentation

slowly enlarging, soft, compressible, mobile mass

Lipoma sonographic appearance (echogenicity and color doppler)

uniform echotexture, ranging from iso-hyperechoic.

has no detectable doppler flow

What internal sonographic feature can be a characteristic of lipoma

linear or gently curving echogenic reflectors running parallel to the skin, which represents fibrous septa

What findings make a presumed lipoma less typical

Focal or abundant vascularity, a deep location, focal markedly hyperechoic areas, or accelerated growth

Where are epidermal inclusion cysts most commonly found

hair-bearing areas, especially the head/neck, trunk, and scrotum (less common in the extremities)

Who are epidermal inclusion cysts more common in

men

Epidermal Inclusion Cyst sonographic appearance (shape, echogenicity, borders, vasculature)

round/ovoid

mildly hyperechoic with posterior through-transmission

well-defined border with hypoechoic halo

heterogeneous

avascular

How can a ruptured or infected epidermal inclusion cyst differ from the typical appearance

It may become lobulated or ill-defined and may show increased Doppler flow and surrounding inflammation

What causes fat necrosis

Vascular impairment or trauma. can also occur after surgery or injections

Fat necrosis sonographic appearance (echogenicity, borders, vasculature)

hyperechoic, poorly marginated, avascular