Abstract
Ultrasonography is commonly requested for evaluation of palpable soft-tissue masses of the extremities in children. Although malignancy is quite rare in these children, it remains a primary diagnostic concern. As a result, knowledge of the common and uncommon soft-tissue lesions as well as sonographic techniques for optimized evaluation are crucial for accurate assessment. This review describe the sonographic imaging appearance of the most commonly encountered superficial soft-tissue lesions at a tertiary academic pediatric hospital. Features of malignancy and findings warranting further evaluation such as lesion size, heterogeneity, vascularity and depth of involvement are also discussed.
Similar content being viewed by others
References
Campbell R (2011) Ultrasound diagnosis of the soft tissue mass: ‘how specific can we be?’ http://wjweiser.com/securesite/iss/meetings/2011/2011%20CD/Presentation%20Abstracts/MUSCULOSKELETAL%20DAY%201/Campbell.pdf. Accessed August 8, 2012
Robinson E, Bleakney RR, Ferguson PC et al (2008) Oncodiagnosis panel: 2007: multidisciplinary management of soft-tissue sarcoma. Radiographics 28:2069–2086
Lakkaraju A, Sinha R, Garikipati R et al (2009) Ultrasound for initial evaluation and triage of clinically suspicious soft-tissue masses. Clin Radiol 64:615–621
Tsou IYY, Tham SC, Wansaicheong GKL (2004) Imaging of the hand. In: Gaitini D, Dogra VS (eds) Musculoskeletal ultrasound with MRI correlations. Thieme Medical Publishers Inc., New York, NY
Blaivas M, Lyon M, Brannam L et al (2004) Water bath evaluation technique for emergency ultrasound of painful superficial structures. Am J Emerg Med 22:589–593
Bodner G, Schocke MF, Rachbauer F et al (2002) Differentiation of malignant and benign musculoskeletal tumors: combined color and power Doppler US and spectral wave analysis. Radiology 223:410–416
Paltiel HJ, Burrows PE, Kozakewich HP et al (2000) Soft-tissue vascular anomalies: utility of US for diagnosis. Radiology 214:747–754
Mulliken JB, Glowacki J (1982) Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg 69:412–422
Enjolras O, Mulliken JB (1993) The current management of vascular birthmarks. Pediatr Dermatol 10:311–313
Donnelly LF, Adams DM, Bisset GS 3rd (2000) Vascular malformations and hemangiomas: a practical approach in a multidisciplinary clinic. AJR Am J Roentgenol 174:597–608
Dubois J, Patriquin HB, Garel L et al (1998) Soft-tissue hemangiomas in infants and children: diagnosis using Doppler sonography. AJR Am J Roentgenol 171:247–252
Gorincour G, Kokta V, Rypens F et al (2005) Imaging characteristics of two subtypes of congenital hemangiomas: rapidly involuting congenital hemangiomas and non-involuting congenital hemangiomas. Pediatr Radiol 35:1178–1185
Dubois J, Garel L, David M et al (2002) Vascular soft-tissue tumors in infancy: distinguishing features on Doppler sonography. AJR Am J Roentgenol 178:1541–1545
Trop I, Dubois J, Guibaud L et al (1999) Soft-tissue venous malformations in pediatric and young adult patients: diagnosis with Doppler US. Radiology 212:841–845
Teefey SA, Dahiya N, Middleton WD et al (2008) Ganglia of the hand and wrist: a sonographic analysis. AJR Am J Roentgenol 191:716–720
Kuwano Y, Ishizaki K, Watanabe R et al (2009) Efficacy of diagnostic ultrasonography of lipomas, epidermal cysts, and ganglions. Arch Dermatol 145:761–764
Bixby SD, Hettmer S, Taylor GA et al (2010) Synovial sarcoma in children: imaging features and common benign mimics. AJR Am J Roentgenol 195:1026–1032
Ahuja AT, Ying M, Ho SY et al (2008) Ultrasound of malignant cervical lymph nodes. Cancer Imaging 8:48–56
Ying M, Ahuja A (2003) Sonography of neck lymph nodes. Part I: normal lymph nodes. Clin Radiol 58:351–358
Ahuja A, Ying M (2003) Sonography of neck lymph nodes. Part II: abnormal lymph nodes. Clin Radiol 58:359–366
Na DG, Lim HK, Byun HS et al (1997) Differential diagnosis of cervical lymphadenopathy: usefulness of color Doppler sonography. AJR Am J Roentgenol 168:1311–1316
Ying M, Ahuja A, Brook F (2004) Accuracy of sonographic vascular features in differentiating different causes of cervical lymphadenopathy. Ultrasound Med Biol 30:441–447
Ryu JK, Jin W, Kim GY (2011) Sonographic appearances of small organizing hematomas and thrombi mimicking superficial soft tissue tumors. J Ultrasound Med 30:1431–1436
Jimenez-Diaz F, Jimena I, Luque E et al (2012) Experimental muscle injury: correlation between ultrasound and histological findings. Muscle Nerve 45:705–712
Chan O, Del Buono A, Best TM et al (2012) Acute muscle strain injuries: a proposed new classification system. Knee Surg Sports Traumatol Arthrosc 20:2356–2362
Lee JC, Healy J (2004) Sonography of lower limb muscle injury. AJR Am J Roentgenol 182:341–351
Tsai TS, Evans HA, Donnelly LF et al (1997) Fat necrosis after trauma: a benign cause of palpable lumps in children. AJR Am J Roentgenol 169:1623–1626
Walsh M, Jacobson JA, Kim SM et al (2008) Sonography of fat necrosis involving the extremity and torso with magnetic resonance imaging and histologic correlation. J Ultrasound Med 27:1751–1757
Navarro OM (2011) Soft tissue masses in children. Radiol Clin North Am 49:1235–1259
Ramirez-Schrempp D, Dorfman DH, Baker WE et al (2009) Ultrasound soft-tissue applications in the pediatric emergency department: to drain or not to drain? Pediatr Emerg Care 25:44–48
Turecki MB, Taljanovic MS, Stubbs AY et al (2010) Imaging of musculoskeletal soft tissue infections. Skeletal Radiol 39:957–971
Seil R, Rupp S, Jochum P et al (1999) Prevalence of popliteal cysts in children. A sonographic study and review of the literature. Arch Orthop Trauma Surg 119:73–75
De Maeseneer M, Debaere C, Desprechins B et al (1999) Popliteal cysts in children: prevalence, appearance and associated findings at MR imaging. Pediatr Radiol 29:605–609
Ward EE, Jacobson JA, Fessell DP et al (2001) Sonographic detection of Baker’s cysts: comparison with MR imaging. AJR Am J Roentgenol 176:373–380
Neubauer H, Morbach H, Schwarz T et al (2011) Popliteal cysts in paediatric patients: clinical characteristics and imaging features on ultrasound and MRI. Arthritis 2011:751593
Walker EA, Fenton ME, Salesky JS et al (2011) Magnetic resonance imaging of benign soft tissue neoplasms in adults. Radiol Clin North Am 49:1197–1217
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 29:887–906
Inampudi P, Jacobson JA, Fessell DP et al (2004) Soft-tissue lipomas: accuracy of sonography in diagnosis with pathologic correlation. Radiology 233:763–767
Moholkar S, Sebire NJ, Roebuck DJ (2006) Radiological-pathological correlation in lipoblastoma and lipoblastomatosis. Pediatr Radiol 36:851–856
Yang DM, Kim HC, Lim JW et al (2007) Sonographic findings of groin masses. J Ultrasound Med 26:605–614
Yuan WH, Hsu HC, Lai YC et al (2012) Differences in sonographic features of ruptured and unruptured epidermal cysts. J Ultrasound Med 31:265–272
Lee HS, Joo KB, Song HT et al (2001) Relationship between sonographic and pathologic findings in epidermal inclusion cysts. J Clin Ultrasound 29:374–383
Kim HK, Kim SM, Lee SH et al (2011) Subcutaneous epidermal inclusion cysts: ultrasound (US) and MR imaging findings. Skeletal Radiol 40:1415–1419
Hwang JY, Lee SW, Lee SM (2005) The common ultrasonographic features of pilomatricoma. J Ultrasound Med 24:1397–1402
Lim HW, Im SA, Lim GY et al (2007) Pilomatricomas in children: imaging characteristics with pathologic correlation. Pediatr Radiol 37:549–555
Murphey MD, Rhee JH, Lewis RB et al (2008) Pigmented villonodular synovitis: radiologic-pathologic correlation. Radiographics 28:1493–1518
Wan JM, Magarelli N, Peh WC et al (2010) Imaging of giant cell tumour of the tendon sheath. Radiol Med 115:141–151
Mohammadi A, Ghasemi-Rad M, Khodabakhsh M (2011) Non-opaque soft tissue foreign body: sonographic findings. BMC Med Imaging 11:9
Vandevenne JE, Colpaert CG, De Schepper AM (1998) Subcutaneous granuloma annulare: MR imaging and literature review. Eur Radiol 8:1363–1365
Grogg KL, Nascimento AG (2001) Subcutaneous granuloma annulare in childhood: clinicopathologic features in 34 cases. Pediatrics 107:E42
Chung S, Frush DP, Prose NS et al (1999) Subcutaneous granuloma annulare: MR imaging features in six children and literature review. Radiology 210:845–849
Enzinger FM, Weiss SW (1995) Soft tissue tumors, 3rd edn. Mosby Inc., St. Louis, MO
Persson BM, Rydholm A (1986) Soft-tissue masses of the locomotor system. A guide to the clinical diagnosis of malignancy. Acta Orthop Scand 57:216–219
Simon MA, Finn HA (1993) Diagnostic strategy for bone and soft-tissue tumors. J Bone Joint Surg Am 75:622–631
Myhre-Jensen O (1981) A consecutive 7-year series of 1,331 benign soft tissue tumours. Clinicopathologic data. Comparison with sarcomas. Acta Orthop Scand 52:287–293
Hussein R, Smith MA (2005) Soft tissue sarcomas: are current referral guidelines sufficient? Ann R Coll Surg Engl 87:171–173
Loizides A, Peer S, Plaikner M et al (2012) Perfusion pattern of musculoskeletal masses using contrast-enhanced ultrasound: a helpful tool for characterisation? Eur Radiol 22:1803–1811
Schulte M, von Baer A, Schultheiss M et al (2010) Classification of solid soft tissue tumours by ultrasonography. Ultraschall Med 31:182–190
Disclaimer
The authors have no financial interests, investigational or off-label uses to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Shah, S.H., Callahan, M.J. Ultrasound evaluation of superficial lumps and bumps of the extremities in children: a 5-year retrospective review. Pediatr Radiol 43 (Suppl 1), 23–40 (2013). https://doi.org/10.1007/s00247-012-2590-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-012-2590-0