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Semin Musculoskelet Radiol 2024; 28(06): 749-757
DOI: 10.1055/s-0044-1791494
Review Article

Ultrasound Spot Diagnosis of Common Benign Subcutaneous Masses and Pseudomasses: What the Radiologist Needs to Know

Raphaël Guillin 
1   Department of Musculoskeletal Imaging, Centre Hospitalier Universitaire de Rennes, Rennes CEDEX, France
,
Isabelle Ract
1   Department of Musculoskeletal Imaging, Centre Hospitalier Universitaire de Rennes, Rennes CEDEX, France
,
Lionel Pesquer
2   Department of Imaging, Clinique du Sport de Bordeaux Mérignac, Mérignac, France
,
Elena Drakonaki
3   Department of Anatomy, Medical School, University of Crete, Heraklion, Crete, Greece
4   Diagnostic and Interventional Ultrasound Practice, Heraklion, Crete, Greece
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Abstract

Common benign subcutaneous benign masses and pseudomasses represent a wide spectrum of masses among which lipomas and epidermal cysts account for a vast majority of the lesions encountered in routine practice. Other types of tumors originate from various components of the skin, such as the pilous tract, nerves, veins, arteries, or eccrine glands. In some instances, pseudomasses may be distinguished from tumoral masses using specific signs. When the diagnosis of a subcutaneous lesion lacks specificity for benignity with ultrasound, radiologists should ensure proper management of the patient to rule out the possibility of a rare but possible sarcoma of the subcutaneous layer.

Keywords

soft tissue tumors - mass - ultrasound - skin


Publication History

Article published online:
19 November 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Jacobson JA, Middleton WD, Allison SJ. et al. Ultrasonography of superficial soft-tissue masses: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology 2022; 304 (01) 18-30
    CrossrefPubMedSearch in Google Scholar
  • 2 Hwang S, Adler RS. Sonographic evaluation of the musculoskeletal soft tissue masses. Ultrasound Q 2005; 21 (04) 259-270
    CrossrefPubMedSearch in Google Scholar
  • 3 Zattar LC, Alves IDS, Bernal ECBA. et al. Radiologic approach for skin US. Radiographics 2022; 42 (02) E73-E74
    CrossrefPubMedSearch in Google Scholar
  • 4 Hung EH, Griffith JF, Ng AW, Lee RK, Lau DT, Leung JC. Ultrasound of musculoskeletal soft-tissue tumors superficial to the investing fascia. AJR Am J Roentgenol 2014; 202 (06) W532-W540
    CrossrefPubMedSearch in Google Scholar
  • 5 Wortsman X, Jemec GBE. eds. Dermatologic Ultrasound with Clinical and Histologic Correlations. New York, NY: Springer Science & Business Media; 2013
    CrossrefSearch in Google Scholar
  • 6 Testut L, Latarjet A. Sens du tact (peau et ses annexes). In: Testut L, Latarjet A. eds. Traité d'anatomie humaine. 9th ed.. Paris, France: Doin; 1949: 462-508
    Search in Google Scholar
  • 7 Stecco C. Deep fasciae. In: Stecco J. ed. Functional Atlas of the Human Fascial System. Philadelphia, PA: Elsevier; 2015: 51-52
    Search in Google Scholar
  • 8 Wortsman X, Carreño L, Ferreira-Wortsman C. et al. Ultrasound characteristics of the hair follicles and tracts, sebaceous glands, Montgomery glands, apocrine glands, and arrector pili muscles. J Ultrasound Med 2019; 38 (08) 1995-2004
    CrossrefPubMedSearch in Google Scholar
  • 9 Kuwano Y, Ishizaki K, Watanabe R, Nanko H. Efficacy of diagnostic ultrasonography of lipomas, epidermal cysts, and ganglions. Arch Dermatol 2009; 145 (07) 761-764
    CrossrefPubMedSearch in Google Scholar
  • 10 Hwang EJ, Yoon HS, Cho S, Park HS. The diagnostic value of ultrasonography with 5-15-MHz probes in benign subcutaneous lesions. Int J Dermatol 2015; 54 (11) e469-e475
    CrossrefPubMedSearch in Google Scholar
  • 11 Fornage BD, Tassin GB. Sonographic appearances of superficial soft tissue lipomas. J Clin Ultrasound 1991; 19 (04) 215-220
    CrossrefPubMedSearch in Google Scholar
  • 12 Roberts CC, Liu PT, Colby TV. Encapsulated versus nonencapsulated superficial fatty masses: a proposed MR imaging classification. AJR Am J Roentgenol 2003; 180 (05) 1419-1422
    CrossrefPubMedSearch in Google Scholar
  • 13 Wagner JM, Lee KS, Rosas H, Kliewer MA. Accuracy of sonographic diagnosis of superficial masses. J Ultrasound Med 2013; 32 (08) 1443-1450
    CrossrefPubMedSearch in Google Scholar
  • 14 Inampudi P, Jacobson JA, Fessell DP. et al. Soft-tissue lipomas: accuracy of sonography in diagnosis with pathologic correlation. Radiology 2004; 233 (03) 763-767
    CrossrefPubMedSearch in Google Scholar
  • 15 Shin YS, Kim YJ, Park IS. et al. Sonographic differentiation between angiolipomas and superficial lipomas. J Ultrasound Med 2016; 35 (11) 2421-2429
    CrossrefPubMedSearch in Google Scholar
  • 16 Moulin B, Messiou C, Crombe A. et al. Diagnosis strategy of adipocytic soft-tissue tumors in adults: a consensus from European experts. Eur J Surg Oncol 2022; 48 (03) 518-525
    CrossrefPubMedSearch in Google Scholar
  • 17 Lee KJ, Jin W, Kim GY. et al. Sonographic features of superficial-type nodular fasciitis in the musculoskeletal system. J Ultrasound Med 2015; 34 (08) 1465-1471
    CrossrefPubMedSearch in Google Scholar
  • 18 Hwang JY, Lee SW, Lee SM. The common ultrasonographic features of pilomatricoma. J Ultrasound Med 2005; 24 (10) 1397-1402
    CrossrefPubMedSearch in Google Scholar
  • 19 Choo HJ, Lee SJ, Lee YH. et al. Pilomatricomas: the diagnostic value of ultrasound. Skeletal Radiol 2010; 39 (03) 243-250
    CrossrefPubMedSearch in Google Scholar
  • 20 Li L, Xu J, Wang S, Yang J. Ultra-high-frequency ultrasound in the evaluation of paediatric pilomatricoma based on the histopathologic classification. Front Med (Lausanne) 2021; 8: 673861
    CrossrefPubMedSearch in Google Scholar
  • 21 Lee JY, Kang BS, Shim HS. et al. Clear cell hidradenoma: characteristic imaging features on ultrasonography, computed tomography, and magnetic resonance imaging. J Ultrasound Med 2018; 37 (08) 1993-2001
    CrossrefPubMedSearch in Google Scholar
  • 22 Wortsman X, Reyes C, Ferreira-Wortsman C, Uribe A, Misad C, Gonzalez S. Sonographic characteristics of apocrine nodular hidradenoma of the skin. J Ultrasound Med 2018; 37 (03) 793-801
    CrossrefPubMedSearch in Google Scholar
  • 23 Reynolds Jr DL, Jacobson JA, Inampudi P, Jamadar DA, Ebrahim FS, Hayes CW. Sonographic characteristics of peripheral nerve sheath tumors. AJR Am J Roentgenol 2004; 182 (03) 741-744
    CrossrefPubMedSearch in Google Scholar
  • 24 Ogata D, Takeji M, Murakami T, Yanagisawa H, Kuramochi A, Tsuchida T. Comparison of ultrasonographic findings of schwannomas and angioleiomyomas. J Dermatol 2018; 45 (07) 837-843
    CrossrefPubMedSearch in Google Scholar
  • 25 Zhang JZ, Zhou J, Zhang ZC. Subcutaneous angioleiomyoma: clinical and sonographic features with histopathologic correlation. J Ultrasound Med 2016; 35 (08) 1669-1673
    CrossrefPubMedSearch in Google Scholar
  • 26 Gomez-Dermit V, Gallardo E, Landeras R, Echevarría F, García Barredo R. Subcutaneous angioleiomyomas: gray-scale and color Doppler sonographic appearances. J Clin Ultrasound 2006; 34 (02) 50-54
    CrossrefPubMedSearch in Google Scholar
  • 27 Park HJ, Kim SS, Lee SY, Choi YJ, Chung EC, Rho MH. Sonographic appearances of soft tissue angioleiomyomas: differences from other circumscribed soft tissue hypervascular tumors. J Ultrasound Med 2012; 31 (10) 1589-1595
    CrossrefPubMedSearch in Google Scholar
  • 28 Kang BS, Shim HS, Kim JH. et al. Angioleiomyoma of the extremities: findings on ultrasonography and magnetic resonance imaging. J Ultrasound Med 2019; 38 (05) 1201-1208
    CrossrefPubMedSearch in Google Scholar
  • 29 Park HJ, Jeon YH, Kim SS. et al. Gray-scale and color Doppler sonographic appearances of nonsubungual soft-tissue glomus tumors. J Clin Ultrasound 2011; 39 (06) 305-309
    CrossrefPubMedSearch in Google Scholar
  • 30 Catalano O, Alfageme Roldän F, Solivetti FM, Scotto di Santolo M, Bouer M, Wortsman X. Color Doppler sonography of extradigital glomus tumors. J Ultrasound Med 2017; 36 (01) 231-238
    CrossrefPubMedSearch in Google Scholar
  • 31 Kim HK, Kim SM, Lee SH, Racadio JM, Shin MJ. Subcutaneous epidermal inclusion cysts: ultrasound (US) and MR imaging findings. Skeletal Radiol 2011; 40 (11) 1415-1419
    CrossrefPubMedSearch in Google Scholar
  • 32 Wortsman X, Wortsman J, Matsuoka L. et al. Sonography in pathologies of scalp and hair. Br J Radiol 2012; 85 (1013): 647-655
    CrossrefPubMedSearch in Google Scholar
  • 33 Huang CC, Ko SF, Huang HY. et al. Epidermal cysts in the superficial soft tissue: sonographic features with an emphasis on the pseudotestis pattern. J Ultrasound Med 2011; 30 (01) 11-17
    CrossrefPubMedSearch in Google Scholar
  • 34 Lee HS, Joo KB, Song HT. et al. Relationship between sonographic and pathologic findings in epidermal inclusion cysts. J Clin Ultrasound 2001; 29 (07) 374-383
    CrossrefPubMedSearch in Google Scholar
  • 35 Malghem J. Kystes épidermoïdes: diagnostic échographique et limites. In: Malghem J. ed. Imagerie de l'appareil musculo-squelettique. Texte choisis. Montpellier, France: Sauramps Medical; 2010: 343-356
    Search in Google Scholar
  • 36 Jin W, Ryu KN, Kim GY, Kim HC, Lee JH, Park JS. Sonographic findings of ruptured epidermal inclusion cysts in superficial soft tissue: emphasis on shapes, pericystic changes, and pericystic vascularity. J Ultrasound Med 2008; 27 (02) 171-176 ; quiz 177–178
    CrossrefPubMedSearch in Google Scholar
  • 37 Clarke R, Suresh P, Thomas R, Freeman S. Twinkle artefact in the ultrasound diagnosis of superficial epidermoid cysts. Ultrasound 2016; 24 (03) 147-153
    CrossrefPubMedSearch in Google Scholar
  • 38 He P, Cui LG, Wang JR, Zhao B, Chen W, Xu Y. Trichilemmal cyst: clinical and sonographic features. J Ultrasound Med 2019; 38 (01) 91-96
    CrossrefPubMedSearch in Google Scholar
  • 39 Ye J, Nappi O, Swanson PE, Patterson JW, Wick MR. Proliferating pilar tumors: a clinicopathologic study of 76 cases with a proposal for definition of benign and malignant variants. Am J Clin Pathol 2004; 122 (04) 566-574
    CrossrefPubMedSearch in Google Scholar
  • 40 Mentes O, Oysul A, Harlak A, Zeybek N, Kozak O, Tufan T. Ultrasonography accurately evaluates the dimension and shape of the pilonidal sinus. Clinics (Sao Paulo) 2009; 64 (03) 189-192
    CrossrefPubMedSearch in Google Scholar
  • 41 Al-Khateeb TH, Al-Masri NM, Al-Zoubi F. Cutaneous cysts of the head and neck. J Oral Maxillofac Surg 2009; 67 (01) 52-57
    CrossrefPubMedSearch in Google Scholar
  • 42 Destek S, Gul VO, Ahioglu S. Rare type cranial postauricular pilonidal sinus: a case report and brief review of literature. Case Rep Surg 2017; 2017: 5791972
    PubMedSearch in Google Scholar
  • 43 Boutin RD, Fritz RC, Steinbach LS. Imaging of sports-related muscle injuries. Radiol Clin North Am 2002; 40 (02) 333-362 , vii
    CrossrefPubMedSearch in Google Scholar
  • 44 Mellado JM, Pérez del Palomar L. Muscle hernias of the lower leg: MRI findings. Skeletal Radiol 1999; 28 (08) 465-469
    CrossrefPubMedSearch in Google Scholar
  • 45 Bouajina E, Harzallah L, Ghannouchi M. et al. Foreign body granuloma due to unsuspected wooden splinter. Joint Bone Spine 2006; 73 (03) 329-331
    CrossrefPubMedSearch in Google Scholar
  • 46 Robinson P, Farrant JM, Bourke G, Merchant W, McKie S, Horgan KJ. Ultrasound and MRI findings in appendicular and truncal fat necrosis. Skeletal Radiol 2008; 37 (03) 217-224
    CrossrefPubMedSearch in Google Scholar
  • 47 Neal C, Jacobson JA, Brandon C, Kalume-Brigido M, Morag Y, Girish G. Sonography of Morel-Lavallee lesions. J Ultrasound Med 2008; 27 (07) 1077-1081
    CrossrefPubMedSearch in Google Scholar
  • 48 Dubois J, Soulez G, Oliva VL, Berthiaume MJ, Lapierre C, Therasse E. Soft-tissue venous malformations in adult patients: imaging and therapeutic issues. Radiographics 2001; 21 (06) 1519-1531
    CrossrefPubMedSearch in Google Scholar
  • 49 Flors L, Leiva-Salinas C, Maged IM. et al. MR imaging of soft-tissue vascular malformations: diagnosis, classification, and therapy follow-up. Radiographics 2011; 31 (05) 1321-1340 ; discussion 1340–1341
    CrossrefPubMedSearch in Google Scholar
  • 50 Starok M, Eilenberg SS, Resnick D. Rheumatoid nodules: MRI characteristics. Clin Imaging 1998; 22 (03) 216-219
    CrossrefPubMedSearch in Google Scholar
  • 51 Gerster JC, Landry M, Dufresne L, Meuwly JY. Imaging of tophaceous gout: computed tomography provides specific images compared with magnetic resonance imaging and ultrasonography. Ann Rheum Dis 2002; 61 (01) 52-54
    CrossrefPubMedSearch in Google Scholar
  • 52 Morel M, Taïeb S, Penel N. et al. Imaging of the most frequent superficial soft-tissue sarcomas. Skeletal Radiol 2011; 40 (03) 271-284
    CrossrefPubMedSearch in Google Scholar
  • 53 Chiou HJ, Chou YH, Chiu SY. et al. Differentiation of benign and malignant superficial soft-tissue masses using grayscale and color Doppler ultrasonography. J Chin Med Assoc 2009; 72 (06) 307-315
    CrossrefPubMedSearch in Google Scholar
  • 54 Galant J, Martí-Bonmatí L, Soler R. et al. Grading of subcutaneous soft tissue tumors by means of their relationship with the superficial fascia on MR imaging. Skeletal Radiol 1998; 27 (12) 657-663
    CrossrefPubMedSearch in Google Scholar
  • 55 Noebauer-Huhmann IM, Vanhoenacker FM, Vilanova JC. et al. Soft tissue tumor imaging in adults: European Society of Musculoskeletal Radiology-Guidelines 2023-overview, and primary local imaging: how and where?. Eur Radiol 2024; 34 (07) 4427-4437
    CrossrefPubMedSearch in Google Scholar
  • 56 Gronchi A, Miah AB, Dei Tos AP. et al; ESMO Guidelines Committee, EURACAN and GENTURIS. Electronic address: clinicalguidelines@esmo.org. Soft tissue and visceral sarcomas: ESMO-EURACAN-GENTURIS Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2021; 32 (11) 1348-1365
    CrossrefPubMedSearch in Google Scholar