Up-to-date imaging review of paediatric soft tissue vascular masses, focusing on sonography

  • Paolo TomàEmail author
  • Francesco Esposito
  • Claudio Granata
  • Guglielmo Paolantonio
  • Maria Chiara Terranova
  • Giuseppe Lo Re
  • Dolores Ferrara
  • Massimo Rollo
  • Massimo Zeccolini
  • Sergio Salerno


The purpose of this article is to provide an up-to-date overview on imaging of paediatric vascular soft tissue masses, including both neoplastic and non-neoplastic lesions. We describe the—often challenging-imaging diagnosis—mainly performed by ultrasound (and secondarily by MRI) and differential diagnosis of vascular soft tissue lesions in children. We underline how important it is to determine whether a vascular anomaly has a regional vascular origin, or if there are other entities, ranging from benign to malignant lesions, which have flow-signal or blood degradation products. Even though clinical examination and patient’s history are the first and indispensable steps in the initial diagnosis, the role of imaging is crucial, not only to determine whether a mass represents a true tumour/pseudo-tumour, but also to achieve a more correct diagnosis and determine the extension of the tumour/pseudo-tumour and its relation with the nearby anatomic structures.


Soft tissue Tumour Pseudo-tumour Vascular malformation Vascular tumour Children Paediatric 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors but is e review of current clinical cases.

Human and animal rights

This article does not contain any studies with animals performed by any of the authors.


  1. 1.
    Navarro OM, Laffan EE, Ngan BY (2009) Pediatric soft-tissue tumors and pseudo-tumors: MR imaging features with pathologic correlation: part 1. Imaging approach, pseudotumors, vascular lesions, and adipocytic tumors. Radiographics 29(3):887–906CrossRefGoogle Scholar
  2. 2.
    Laffan EE, Ngan BY, Navarro OM (2009) Pediatric soft-tissue tumors and pseudotumors: MR imaging features with pathologic correlation: part 2 Tumors of fibroblastic/myofibroblastic, so-called fibrohistiocytic, muscular, lymphomatous, neurogenic, hair matrix, and uncertain origin. Radiographics 29(4):e36CrossRefGoogle Scholar
  3. 3.
    Johnson CM, Navarro OM (2017) Clinical and sonographic features of pediatric soft-tissue vascular anomalies part 1: classification, sonographic approach and vascular tumors. Pediat Radiol 47(9):1184–1195CrossRefGoogle Scholar
  4. 4.
    Johnson CM, Navarro OM (2017) Clinical and sonographic features of pediatric soft-tissue vascular anomalies part 2: vascular malformations. Pediatr Radiol 47(9):1196–1208CrossRefGoogle Scholar
  5. 5.
    De Schepper AM et al (2000) Magnetic resonance imaging of soft tissue tumors. European radiology 10(2):213–223CrossRefGoogle Scholar
  6. 6.
    McCarville MB, Spunt SL, Pappo AS (2001) Rhabdomyosarcoma in pediatric patients: the good, the bad, and the unusual. AJR 176:1563–1569CrossRefGoogle Scholar
  7. 7.
    Brisse HJ, Orbach D, Klijanienko J (2010) Soft tissue tumours: imaging strategy. Pediatr Radiol 40:1019–1028CrossRefGoogle Scholar
  8. 8.
    Fletcher CDM (2014) The evolving classification of soft tissue tumours – an update based on the new 2013 WHO classification. Histopathology 64:2–11CrossRefGoogle Scholar
  9. 9.
    Enzinger FM, Weiss SW (1995) Soft tissue tumors. Mosby, St. LouisGoogle Scholar
  10. 10.
    Carli M, Cecchetto G, Sotti G, Allaggio R, Stevens M (2004) Soft tissue sarcomas. In: Pinkerton C, Plowman P (eds) Paediatric Oncology. Arnold, London, pp 339–370Google Scholar
  11. 11.
    Johnson CJ, Pynsent PB, Grimer RJ (2001) Clinical features of soft tissue sarcomas. Ann R Coll Surg Engl 83:203–205Google Scholar
  12. 12.
    Morón FE, Morriss MC, Jones JJ, Hunter JV (2004) Lumps and bumps on the head in children: use of CT and MR imaging in solving the clinical diagnostic dilemma. Radiographics 24(6):1655–1674CrossRefGoogle Scholar
  13. 13.
    Purohit B, Yeong SS, Kapur J (2014) Sonographic pictorial review of benign palpable paediatric lumps: head to foot. Med J Malaysia 69(2):105Google Scholar
  14. 14.
    Dubois J, Garel L (1999) Imaging and therapeutic approach of hemangiomas and vascular malformations in the pediatric age group. Pediatr Radiol 29:879–893CrossRefGoogle Scholar
  15. 15.
    Rogers M, Lam A, Fischer G (2002) Sonographic findings in a series of rapidly involuting congenital emangiomas (RICH). Pediatr Dermatol 19:5–11CrossRefGoogle Scholar
  16. 16.
    Moholkar S, Sebire NJ, Roebuck DJ (2006) Radiological–pathological correlation in lipoblastoma and lipoblastomatosis. Pediatr Radiol 36(8):851–856CrossRefGoogle Scholar
  17. 17.
    Yilmaz S, Ozolek JA, Zammerilla LL, Fitz CR, Grunwaldt LJ, Crowley JJ (2014) Neurofibromas with imaging characteristics resembling vascular anomalies. Am J Roentgenol 203(6):W697–W705CrossRefGoogle Scholar
  18. 18.
    Chee DW, Peh WC, Shek TW (2011) Pictorial essay: imaging of peripheral nerve sheath tumours. Can Assoc Radiol J 62(3):176–182CrossRefGoogle Scholar
  19. 19.
    Lee S, Choi YH, Cheon JE, Kim MJ, Lee MJ, Koh MJ (2014) Ultrasonographic features of fibrous hamartoma of infancy. Skeletal Radiol 43(5):649–653CrossRefGoogle Scholar
  20. 20.
    Arioni C, Bellini C, Oddone M, Risso FM, Scopesi F, Nozza P, Serra G, Tomà P (2006) Congenital fibrous hamartoma of the knee. Pediatr Radiol 36(5):453–455CrossRefGoogle Scholar
  21. 21.
    Bansal AG, Oudsema R, Masseaux JA, Rosenberg HK (2018) US of Pediatric Superficial Masses of the Head and Neck. RadioGraphics 38(4):1239–1263CrossRefGoogle Scholar
  22. 22.
    Adhikari S, Blaivas M (2012) Sonography first for subcutaneous abscess and cellulitis evaluation. J Ultrasound Med 31(10):1509–1512CrossRefGoogle Scholar
  23. 23.
    De Beuckeleer LH, De Schepper AM, Vandevenne JE, Bloem JL, Davies AM, Oudkerk M, Hauben E, Van Marck E, Somville J, Vanel D, Steinbach LS (2000) MR imaging of clear cell sarcoma (malignant melanoma of the soft parts): a multicenter correlative MRI-pathology study of 21 cases and literature review. Skeletal Radiol 29(4):187–195CrossRefGoogle Scholar
  24. 24.
    Jin W, Kim GY, Lew BL, Yang DM, Kim HC, Ryu JK, Park JS, Ryu KN (2008) Sonographic findings of an eccrine spiradenoma: case report and literature review. J Ultrasound Med 27(5):813–818CrossRefGoogle Scholar
  25. 25.
    Han YD, Huan Y, Deng JL, Zhang YG, Zhang CH (2007) MRI appearance of multiple eccrine spiradenoma. Br J Radiol 80(949):e27–e29CrossRefGoogle Scholar
  26. 26.
    Sargar KM, Sheybani EF, Shenoy A, Aranake-Chrisinger J, Khanna G (2016) Pediatric fibroblastic and myofibroblastic tumors: a pictorial review. Radiographics 36(4):1195–1214CrossRefGoogle Scholar
  27. 27.
    Dubois J, Patriquin HB, Garel L et al (1998) Soft-tissue hemangiomas in infants and children: diagnosis using Doppler sonography. AJR Am J Roentgenol 171:247–252CrossRefGoogle Scholar
  28. 28.
    Dubois J, Alison M (2010) Vascular anomalies: what a radiologist needs to know. Pediatr Radiol 40:895–905CrossRefGoogle Scholar
  29. 29.
    Uller W, Alomari AI, Richter GT (2014) Arteriovenous malformations. Semin Pediatr Surg 23:203–207CrossRefGoogle Scholar
  30. 30.
    Legiehn GM, Heran MK (2006) Classification, diagnosis and interventional radiologic management of vascular malformations. Orthop Clin N Am 37:435–474CrossRefGoogle Scholar
  31. 31.
    Colmenero I, Hoeger PH (2014) Vascular tumours in infants. Part II: vascular tumours of intermediate dignity and malignant tumours. Br J Dermatol 171:474–484CrossRefGoogle Scholar
  32. 32.
    Konez O, Burrows PE (2002) Magnetic resonance of vascular anomalies. Magn Reson Imaging Clin N Am 10:363–388CrossRefGoogle Scholar
  33. 33.
    Dudea SM, Lenghel M, Vasilescu D, Duma MM (2012) Ultrasonography of superficial lymph nodes: benign vs malignant. Med Ultrasonogr 14(4):294–306Google Scholar
  34. 34.
    Wortsman X, Wortsman J, Arellano J, Oroz J, Giugliano C, Benavides MI, Bordon C (2010) Pilomatrixomas presenting as vascular tumors on color Doppler ultrasound. J Pediatr Surg 45(10):2094–2098CrossRefGoogle Scholar
  35. 35.
    Dasgupta NR, Bentz ML (2003) Nasal gliomas: identification and differentiation from hemangiomas. J Craniofacial Surg 14(5):736–738CrossRefGoogle Scholar
  36. 36.
    Oddone M, Granata C, Dalmonte P, Biscaldi E, Rossi U, Toma P (2002) Nasal glioma in an infant. Pediatr Radiol 32(2):104–105CrossRefGoogle Scholar
  37. 37.
    Abate M, Salini V, Rimondi E, Errani C, Alberghini M, Mercuri M, Pelotti P (2011) Post traumatic myositis ossificans: sonographic findings. J Clin Ultrasound 39(3):135–140CrossRefGoogle Scholar
  38. 38.
    Pang LM, Roebuck DJ, Griffith JF, Kumta SM, Metreweli C (2001) Alveolar soft part sarcoma: a rare soft-tissue malignancy with distinctive clinical and radiological features. Pediatr Radiol 31:196–199CrossRefGoogle Scholar
  39. 39.
    Murphey MD, Gibson MS, Jennings BT, Crespo-Rodríguez AM, Fanburg-Smith J, Gajewski DA (2006) Imaging of synovial sarcoma with radiologic-pathologic correlation. Radiographics 26(5):1543–1565CrossRefGoogle Scholar
  40. 40.
    Acevedo JL, Shah RK, Brietzke SE (2008) Nonsurgical therapies for lymphangiomas: a systematic review. Otolaryngol Head Neck Surg 138:418–424CrossRefGoogle Scholar
  41. 41.
    Kasabach H, Merritt K (1940) Capillary hemangioma with extensive purpura: report of a case. Am J Dis Child 59:1063–1070CrossRefGoogle Scholar
  42. 42.
    Khuu A, Yablon CM, Jacobson JA, Inyang A, Lucas DR, Biermann JS (2014) Nodular fasciitis: characteristic imaging features on sonography and magnetic resonance imaging. Journal of Ultrasound in Medicine. 33(4):565–573CrossRefGoogle Scholar
  43. 43.
    Pham H, Fessell DP, Femino JE, Sharp S, Jacobson JA, Hayes CW (2003) Sonography and MR imaging of selected benign masses in the ankle and foot. American Journal of Roentgenology. 180(1):99–107CrossRefGoogle Scholar
  44. 44.
    Gokli A, Neuman J, Lukse R, Koshy J, Kong F, Laor T (2016) Childhood asymmetrical labium majus enlargement sonographic and MR imaging appearances. Pediatric radiology. 46(5):674–679CrossRefGoogle Scholar
  45. 45.
    Enjolras O, Wassef M, Chapot R (2007) Color atlas of vascular tumors and vascular malformations, 1st edn. Cambridge University Press, New YorkCrossRefGoogle Scholar
  46. 46.
    Paltiel HJ, Burrows PE, Kozakewich HP et al (2000) Soft-tissue vascular anomalies: utility of US for diagnosis. Radiology 214:747–754CrossRefGoogle Scholar
  47. 47.
    Cahill AM, Nijs EL (2011) Pediatric vascular malformations: pathophysiology, diagnosis, and the role of interventional radiology. Cardiovasc Intervent Radiol 34:691–704CrossRefGoogle Scholar
  48. 48.
    Morrow MS, Oliveira AM (2014) Imaging of lumps and bumps in pediatric patients: an algorithm for appropriate imaging and pictorial review. Semin Ultrasound CT MR 35:415–429CrossRefGoogle Scholar

Copyright information

© Italian Society of Medical Radiology 2019

Authors and Affiliations

  1. 1.Department of ImagingBambino Gesù Children’s Hospital IRCCSRomeItaly
  2. 2.Radiology Department“Santobono-Pausilipon” Children HospitalNaplesItaly
  3. 3.Department of RadiologyG. Gaslini Institute, IRCCSGenovaItaly
  4. 4.Interventional Radiology Unit, Department of ImagingBambino Gesù Children’s Hospital IRCCSRomeItaly
  5. 5.Department of Biopathology and Medical Biotechnologies (DI.BI.MED)Policlinico University of PalermoPalermoItaly
  6. 6.Department of Advanced Biomedical SciencesUniversity “Federico II”NaplesItaly

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