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Showing posts with label USG MSK. Show all posts
Showing posts with label USG MSK. Show all posts

Case 114: Supraclavicular Superficial Lipoma || Ultrasound

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Clinical Features:

A 34-year-old male patient came with a right supraclavicular lump for 4 years.


Ultrasound Features:

- A well-defined oblong-shaped encapsulated compressible hyperechoic area with internal fine linear striations parallel to the skin indicating fatty lesion is seen at the subcutaneous layer of the right supraclavicular region.

- Color Doppler shows no internal or abnormal peripheral vascularity.


Remember:

- If lipomas are painful or tender, then they are known as Dercum disease or adiposis dolorosa.
- Consider angiolipoma if mild to moderate internal vascularity is present.


Ultrasound Diagnosis:

Supraclavicular Superficial Lipoma


Ultrasound Images:





Supraclavicular superficial lipoma on grayscale images







Supraclavicular superficial lipoma on 3D images


YouTube Link:

For further demonstration, don't forget to check our video:

YouTube Link






Case 113: Ganglion Cyst - Pseudosolid Appearance || Ultrasound

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Clinical Features:

A 70-year-old male patient came with right dorsal wrist swelling & pain.


Ultrasound Features:

- A well-defined ovoid hypoechoic area with a stalk extending toward joint seen at the dorsal aspect of the lateral part of wrist.

- Color Doppler shows no internal vascularity. 


Remember:

- Stalk extending toward joint & no internal vascularity may help differentiate from other tumors.
- Pseudosolid appearance may indicate internal hemorrhage.


Ultrasound Diagnosis:

Ganglion cyst at the wrist.


Ultrasound Images:






A well-defined ovoid hypoechoic area with a stalk extending toward joint seen at the dorsal aspect of the lateral part of wrist. Color Doppler shows no internal vascularity. 


YouTube Link:

For further demonstration, don't forget to check our video:

YouTube Link








Case 110: Soft Tissue Sarcoma || Ultrasound

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Clinical Features:

A 47-year-old male came with

- Right lower thigh lump at the postero-lateral aspect.

- H/o previous surgical removal of the tumor.


Ultrasound Features:

- An irregular, heterogeneous, hypoechoic mass with internal few cystic spaces of necrosis noted deep to the subcutaneous layer of the postero-lateral aspect of the lower thigh compressing the surrounding soft tissues.

- Color Doppler shows hypervascularity with disorganized vascular pattern.


Remember:

Any large (>5cm), solid, nonfatty soft tissue tumor should be considered sarcoma unless proven otherwise by biopsy.


Ultrasound Diagnosis:

Soft tissue mass lesion at the posterolateral aspect of the right lower thigh, possibly sarcoma.


Ultrasound Images:






Sarcoma at the lower thigh







Hypervascularity on Doppler







3D Doppler images






Multi-planar 3D

YouTube Link:

For further demonstration, don't forget to check our video:

YouTube Link









Case 99: Superficial Hemangioma || Ultrasound

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Clinical Features:

A 7-year-old boy came with a bluish lump at the right superior aspect of the back of the chest.


Ultrasound Features:

- An oval lobulated hypoechoic area is noted at the subcutaneous layer of the back of the chest.

- Color Doppler shows high vascularity within the lesion of both arterial & venous types. 

- The feeding artery arises from adjacent chest wall arteries with a high velocity moderate resistant flow. 


Remember:

Whenever you get a lipoma-like mass in a child, use color Doppler to exclude hemangioma.


Ultrasound Diagnosis:

Superficial Hemangioma


Ultrasound Images:




Oval lobulated hemangioma is noted at the subcutaneous layer of the back of the chest


Color Doppler shows high vascularity within the lesion of both arterial & venous types



The feeding artery arises from adjacent chest wall arteries with a high velocity moderate resistant flow


B-flow shows high vascularity within the lesion 



Power Doppler shows high vascularity within the lesion 


3D ultrasound of the lesion


Hemangioma with convex transducer showing no intrathoracic extension

YouTube Link:

For further demonstration, don't forget to check our video:


YouTube Link










Case 98: Peripheral Nerve Sheath Tumor || Ultrasound

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Clinical Features:

A 67-year-old male patient came with right calf swelling for 2 years.


Ultrasound Features:

- An ovoid heterogeneously hypoechoic well-defined mass with tapered ends with no definite surrounding architectural distortion is noted along the right gastrocnemius muscle.

- Color Doppler shows internal vascularity with predominantly peripheral flow (RI: 0.84).


Remember:

- Target sign: Central hyperechogenicity representing fibrocollagenous component surrounded by peripheral hypoechogenicity representing myxoid component; more commonly seen in neurofibroma.

- Intratumoral hemorrhage may lead to sudden increase in tumor size.


Ultrasound Diagnosis:

Peripheral Nerve Sheath Tumor 


Ultrasound Images:





An ovoid heterogeneously hypoechoic well-defined mass with tapered ends with no definite surrounding architectural distortion is noted along the right gastrocnemius muscle


Tapered end shows tibial nerve


Moderate vascularity on power Doppler



Moderate vascularity on color Doppler


Spectral Doppler shows high resistant flow in the supplying artery


3D view of the tumor

YouTube Link:

For further demonstration, don't forget to check our video:

YouTube Link