Skeletal Radiology

, Volume 40, Issue 11, pp 1415–1419 | Cite as

Subcutaneous epidermal inclusion cysts: Ultrasound (US) and MR imaging findings

  • Hee Kyung Kim
  • Sung Moon Kim
  • Sang Hoon Lee
  • Judy M. Racadio
  • Myung Jin ShinEmail author
Scientific Article



To describe the characteristic US and MR findings of subcutaneous epidermal inclusion cysts.

Materials and methods

Seventy-nine patients with subcutaneous epidermal inclusion cysts underwent US (n = 70), MR (n = 7), or both (n = 2). On US, the margin, shape, echogenicity, through-transmission, wall, internal debris and vascularity were evaluated. On MR, the shape, wall, signal intensity, internal debris, and enhancement pattern were evaluated.


On US, characteristic findings were well circumscribed (n = 69, 96%), ovoid-shaped (n = 56, 78%), heterogeneously and mildly echogenic (n = 66, 92%), increased through-transmission (n = 66, 92%) and low echoic rim (n = 48, 67%). Internal debris was seen in 31 cases (43%) and often contained linear echogenic reflections (n = 12, 17%), dark clefts (n = 13, 18%), or a mixture (n = 5, 7%). Most masses showed no Doppler flow (n = 70, 97%). On MR, all cases demonstrated a well-demarcated oval-shaped mass with a surrounding rim. On T1-weighted image (WI), the mass showed slightly high T1 signal in 4/9 (44%) and iso-signal in 5/9 (56%). On T2WI, the mass showed high signal in 6/9 (67%), intermediate in 2/9 (22%), and a target appearance in 1/9 (11%). Internal linear dark T2 signal debris was observed in 4/9 (44%). All lesions showed peripheral rim enhancement without central enhancement.


On US, subcutaneous epidermal inclusion cysts are usually well-circumscribed, oval-shaped, mildly echogenic masses with occasional linear anechoic and/or echogenic reflections, increased through-transmission, hypoechoic rim and no Doppler flow. On MR, an intermediate to high T2 signal mass with occasional low signal debris and no central enhancement can strengthen the diagnosis.


Ultrasound MR Epidermal inclusion cyst 


The authors declare that there are no conflicts of interest.


  1. 1.
    Lever WF, Lever GS. Tumor and cysts of epidermis. In: Elder D, editor. Histopathology of the skin. 8th ed. Philadelphia, JB: Lippincott, 1997, p. 685-746Google Scholar
  2. 2.
    Elder D, Elenitsas R, Jaworsky C, Johnson Jr B. Lever’s histopathology of the skin. 8th ed. Philadelphia: Lippincott-Raven; 1997. p. 695–721.Google Scholar
  3. 3.
    Denison CM, Ward VL, Lester SC, DiPiro PJ, Smith DN, Meyer JE, et al. Epidermal inclusion cysts of the breast: Three lesions with calcifications. Radiology. 1997;204(2):493–6.PubMedGoogle Scholar
  4. 4.
    Yasumoto M, Shibuya H, Gomi N, Kasuga T. Ultrasonographic appearance of dermoid and epidermoid cysts in the head and neck. J Clin Ultrasound. 1991;19(8):455–61.PubMedCrossRefGoogle Scholar
  5. 5.
    Dogra V. Testicular epidermoid cysts. Am J Roentgenol. 2002;179(4):1075–5.Google Scholar
  6. 6.
    Jackson VP, Edmond VJ. Breast ultrasonography. In: LW JVP, Fu KL, Fu YS, editors. Diagnosis of disease of the breast. 2nd ed. Philadelphia: Elsevier Saunders; 2005. p. 175–92.Google Scholar
  7. 7.
    Yang DM, Yoon MH, Kim HS, Oh YH, Ha SY, Oh JH, et al. Presacral epidermoid cyst: imaging findings with histopathologic correlation. Abdom Imaging. 2001;26(1):79–82.PubMedCrossRefGoogle Scholar
  8. 8.
    Eisenmenger M, Lang S, Donner G, Kratzik C, Marberger M. Epidermoid cysts of the testis: organ-preserving surgery following diagnosis by ultrasonography. Br J Urol. 1993;72(6):955–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Langer JE, Ramchandani P, Siegelman ES, Banner MP. Epidermoid cysts of the testicle: Sonographic and MR imaging features. Am J Roentgenol. 1999;173(5):1295–9.Google Scholar
  10. 10.
    Shibata T, Hatori M, Satoh T, Ehara S, Kokubun S. Magnetic resonance imaging features of epidermoid cyst in the extremities. Arch Orthop Traum Su. 2003;123(5):239–41.Google Scholar
  11. 11.
    Hong SH, Chung HW, Choi JY, Koh YH, Choi JA, Kang HS. MRI findings of subcutaneous epidermal cysts: emphasis on the presence of rupture. AJR Am J Roentgenol. 2006;186(4):961–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Brenner JS, Cumming WA, Ros PR. Testicular epidermoid cyst—sonographic and MR findings. Am J Roentgenol. 1989;152(6):1344–4.Google Scholar
  13. 13.
    Cho JH, Chang JC, Park BH, Lee JG, Son CH. Sonographic and MR imaging findings of testicular epidermoid cysts. Am J Roentgenol. 2002;178(3):743–8.Google Scholar

Copyright information

© ISS 2010

Authors and Affiliations

  • Hee Kyung Kim
    • 1
    • 2
  • Sung Moon Kim
    • 1
    • 3
  • Sang Hoon Lee
    • 1
  • Judy M. Racadio
    • 2
  • Myung Jin Shin
    • 1
    Email author
  1. 1.Department of Radiology and Research InstituteUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulKorea
  2. 2.Department of RadiologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  3. 3.Department of RadiologyUniversity of Michigan HospitalsAnn ArborUSA

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