Thread by @Mike_tordjman

1- Everything you need to know about ultrasonography of Superficial Soft Tissue masses in this #Tweetorial based on the Conference Consensus Statement published in @radiology_rsna: doi.org/10.1148/radiol…
#RadIntraining @RadITrainingEditor @RadiologyEditor @jjacobsn
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2- In small superficial soft tissue masses, ultrasonography is an excellent examination, allowing real-time manual compression, direct patient interaction and study with Doppler. Deeper lesions often require MRI for further characterization.
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3- Among the following ultrasound criteria, which one is atypical of lipoma?
A-Gently curved echogenic lines parallel to the skin surface
B-Non compressible mass
C-Iso or hyperechoic compared with adjacent subcutaneous tissue
D-No detectable internal blood flow on Doppler US

4- Lipomas are usually iso or hyperechoic, oval, compressible, with no or minimal septal vascularity. Deep location, abundant or focal vascularity and accelerated growth are atypical findings. Contrast-enhanced MRI and surgical consultation are recommended if atypical. 4/15

5- Among the following ultrasound criteria, which one is atypical of Epidermal Inclusion Cyst?
A-Ovoid mass with no internal flow on Doppler US images
B-Mildly hyperechoic with internal heterogeneity
C-Increased posterior through-transmission
D-Calcification

6- Epidermal Inclusion Cyst is a superficial lesion involving hair-bearing areas. It is ovoid, mildly hyperechoic, with linear low-echogenic areas, scattered areas of bright linear echoes, and anechoic debris. Calcification is rare and there is no internal blood flow. 6/15

7- Among the following ultrasound criteria, which one is atypical of benign Peripheral Nerve Sheath Tumor?
A-Nerve continuity
B-Increased posterior through-transmission
C-Severe pain with biopsy
D-Heterogeneous echogenicity

8- Benign Peripheral Nerve Sheath Tumor are usually homogeneous, hypoechoic, with increased posterior through-transmission and direct continuity with a peripheral nerve (pathognomonic). Large mass with central necrosis and rapid growth should raise the possibility of malignancy.

9- Vascular Tumors and Malformations have a heterogeneous appearance with both hyper- and hypoechoic regions and a tangle of vessels with low or high flow. Hyperechoic foci with shadowing are due to phleboliths. 9/15

10- Which one of the following criteria is not predictive of malignant lymphadenopathy?
A-Asymmetrically thickened cortex
B-Loss of the central hyperechoic hilum
C-Increased size
D-Calcifications

11- In case of enlarged nodes, benign reactive nodes, lymphoma and metastatic disease must be considered. Reactive lymph nodes preserve their normal architecture. Size alone is unreliable in predicting malignancy. Shown below is a metastatic disease. 11/15

12- A predominantly hypoechoic fluid collection with increased posterior through transmission and mobile internal echoes with sonopalpation is characteristic of:
A-Hematoma
B-Bursal disease
C-Abscess
D-Malignant mass

13- Fluid collections can be from multiple causes. A predominantly hypoechoic fluid collection with mobile internal echoes is characteristic of an abscess in the appropriate clinical setting. The echotexture of a hematoma can vary from hyperechoic to anechoic. 13/15

14- CLINICAL IMPLICATIONS: The report of superficial soft-tissue masses should include composition, location, size, relationship to adjacent structures, echogenicity, margins, vascularity. It also should contain a defined recommendation for further care. 14/15

15. More: doi.org/10.1148/radiol… 15/15
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