Case 114: Supraclavicular Superficial Lipoma || Ultrasound

              

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

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Case 113: Ganglion Cyst - Pseudosolid Appearance || Ultrasound

             

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. 

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Case 110: Soft Tissue Sarcoma || Ultrasound

          

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

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Case 109: Midline Epigastric Hernia || Ultrasound

          

Clinical Features:

A 40-year-old female came with occasional epigastric swelling.

Ultrasound Features:

- A herniated sac is noted at the midline epigastric region.

- Content appears to be reducible omental fat.

Remember:

Color Doppler may help exclude strangulation in an obstructed hernia.

Ultrasound Diagnosis:

Midline Epigastric Reducible Hernia

Ultrasound Images:

A herniated sac is noted at the midline epigastric region having reducible omental fat as content

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Case 108: Post-injection Abscess || Ultrasound

         

Clinical Features:

A 45-year-old female diabetic patient came with 

- Painful left lateral arm swelling.

- H/o injection at that region.

Ultrasound Features:

- An irregular, complex fluid collection with internal low-level echoes & surrounding subcutaneous tissue edema are noted within the subcutaneous layer at the lateral aspect of the forearm.

- Color Doppler shows increased surrounding vascularity.

Remember:

When an abscess is found near a bone, check the adjacent bony irregularity & communication with the bone. 

Ultrasound Diagnosis:

Superficial abscess of the left lateral arm.

Ultrasound Images:

Irregular, complex fluid collection with internal low-level echoes & surrounding subcutaneous tissue edema are noted within the subcutaneous layer at the lateral aspect of the forearm

Color Doppler shows increased peripheral vascularity

Spectral Doppler shows monophasic hyperemic flow in a peripheral superficial artery.

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Case 99: Superficial Hemangioma || Ultrasound

    

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

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