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Ultrasound of Soft Tissue Masses
Levon N. Nazarian, MDProfessor of Radiology
Thomas Jefferson University Hospital
Disclosures
Nothing to disclose relatedto th is CME activity
Educational Objectives
Following the presentation,participant should be able to:
Describe the use of US in theevaluation of superfic ial
softtissue masses
Identify common massesencountered in practice anddiscuss their
differentialdiagnosis
General Approach to aSuspected Soft Tissue Mass
Take a thorough history
If palpable, have patient poin tto area of interest
If non-palpable, consultcorrelative imaging (CT, MRI,etc.)
Painful or asymptomatic
Stable or growing
General Approach to aSuspected Soft Tissue Mass
Potentially pertinent medicalhistory
Prior malignancy
Trauma
Surgery
Anticoagulat ion
Systemic d iseases
US Approach to Soft Tissue Masses
Size
Measure 3 dimensions Echogenicity
Hypoechoic
Isoechoic
Hyperechoic
Mixed
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US Approach to Soft Tissue Masses
BordersWell-defined
Blends in with surroundingtissues
Effect on US beam
Acoust ic enhancement
Shadowing
Doppler US Technique
Minimize depth, place focalzone at level of lesion
Assess vasculari ty in andaround lesion
Color Doppler
Power Doppler
Spectral Doppler
Normal Soft Tissues
Localize Mass toCompartment(s)
Skin
Subcutaneous tissues
Muscle
Joints / bursae
Other MSK
Fatty Masses
Lipoma
LiposarcomaAsymmetric fat deposit ion
Fat necrosis
Lipoma
Range from hyperechoic toisoechoic to hypoechoic
May see internal septations
Difficult to separate fromadjacent fat
Little or no Doppler flow
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LipomaLipoma
Lipoma: Color Doppler Lipoma: EFOV
Lipoma Lipoma: Color Doppler
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Lipoma: B ilateralComparison
Lipoma: EFOV
Lipoma
Biceps Mass
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Biceps MassBiceps Mass
Suspected Biceps RuptureSuspected Biceps Rupture
Liposarcoma Liposarcoma
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Fat Necrosis
Palpable nodule May be painful
Etiology
Direct trauma
Collagen vascular d iseases
Medications
Fat Necrosis
Fat NecrosisCystic Fat Necrosis
Cystic vs. Solid Mass
Gray scale appearance
Acoust ic enhancement does
not mean mass is cystic Change with compression?
Internal Doppler fl ow
If present, excludes fluidcollection
If absent, still may be solid
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Fluid CollectionCompression
US-guided Biopsy
Grey scale and color
Doppler characteristicsoften nonspecific
Percutaneous biopsy safeand effective for diagnosis
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The Real Estate Approach
LOCATION, LOCATION,LOCATION
Bakers Cyst
Rule out Bakers Cyst Rule out Bakers Cyst
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PET CT of LowerExtremity
Rhematoid Nodule: ExtensorSurface of Elbow
OLECRANON
Neurofibroma of Ankle Neurofibroma of Ankle
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Stump Neuroma
*N
Evaluation of VascularMasses
Amount of flow Type: arterial and/or venous
Distribution: central and/orperipheral
Power Doppler for i ncreasedsensitivity
Spectral Doppler for con firmation
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Finger Hemangioma
Finger HemangiomaLymph Nodes: Benign
Features
Oval shape
Length to AP > 2 (Solbiati)
Preserved echogenic hilum
Homogeneous echotexture
Regular Doppler flow pattern
Normal Lymph Node Inguinal Lymph Node Metastasis
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Normal Lymph Node Flow Metastatic Melanoma Flow
PeriarticularProcesses
Bursitis
Ganglion cysts
Distended Iliopsoas Bursa
Wrist Ganglion Wrist Ganglion
R
S
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Muscles
Traumatic rupture orherniation
Hematoma
Abscess / pyomyosi tis
Myositis ossificans
Neoplasms
18-year-old Lacrosse Playerwith a Painful Thigh
Rule out sarcomaMass in Paraspinal Muscle
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Biopsy of Muscle Mass Pain After C-Section
Conclusion
US is useful in di fferential diagnosisof a wide array of soft
tissue masses
Use correlative imaging whennecessary
When in doubt, get tissue diagnosis
Two virtually useless features
Presence of through transmiss ion
Shape of Doppler waveform
