Abstract
Ultrasound (US) is the imaging modality of choice for evaluation of superficial palpable lesions. A large proportion of these lesions have characteristic sonographic appearance and can be confidently diagnosed with US without the need for biopsy or other intervention. The Society of Radiologists in Ultrasound (SRU) recently published a Consensus Conference Statement on superficial soft tissue masses. The goal of this manuscript is (a) to serve as a sonographic pictorial review for palpable lesions based on the SRU statement, (b) present the typical sonographic features of palpable lesions that can be confidently diagnosed with US, and (c) provide an overview of other palpable lesions with a framework to interpret the US studies and advise on appropriate further management.
Similar content being viewed by others
References
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(1):18-30.
Lebow J. Models for evaluating services at community mental health centers. Hosp Community Psychiatry. 1982;33(12):1010-1014.
Goh LW, Wong SL, Tan PH. Four cases of echogenic breast lesions: a case series and review. Singapore Med J. 2016;57(6):339-343.
Toprak H, Kilic E, Serter A, Kocakoc E, Ozgocmen S. Ultrasound and Doppler US in Evaluation of Superficial Soft-tissue Lesions. J Clin Imaging Sci. 2014;4:12.
Ahuja AT, King AD, Kew J, King W, Metreweli C. Head and neck lipomas: sonographic appearance. AJNR Am J Neuroradiol. 1998;19(3):505-508.
Onesti MG, Maruccia M, Malpassini F, et al. A case of subfascial lipoma in the lateral space of neck: US and CT findings. J Ultrasound. 2009;12(4):160-162.
Kolb L, Yarrarapu SNS, Ameer MA, Rosario-Collazo JA. Lipoma. In: StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Siva Naga Yarrarapu declares no relevant financial relationships with ineligible companies. Disclosure: Muhammad Atif Ameer declares no relevant financial relationships with ineligible companies. Disclosure: Juan Rosario-Collazo declares no relevant financial relationships with ineligible companies.2023.
Charifa A, Azmat CE, Badri T. Lipoma Pathology. In: StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Chaudhary Ehtsham Azmat declares no relevant financial relationships with ineligible companies. Disclosure: Talel Badri declares no relevant financial relationships with ineligible companies.2023.
Wagner JM, Lee KS, Rosas H, Kliewer MA. Accuracy of sonographic diagnosis of superficial masses. J Ultrasound Med. 2013;32(8):1443-1450.
Vivitmongkonchai K, Wangcharoenrung D, Kintarak J. Sonographic Appearance of Soft Tissue Lipomas. J Med Assoc Thai. 2016;99 Suppl 4:S69-74.
Paunipagar BK, Griffith JF, Rasalkar DD, Chow LT, Kumta SM, Ahuja A. Ultrasound features of deep-seated lipomas. Insights Imaging. 2010;1(3):149-153.
Shimamori N, Kishino T, Okabe N, et al. Discrimination of well-differentiated liposarcoma from benign lipoma on sonography: an uncontrolled retrospective study. J Med Ultrason (2001). 2020;47(4):617-623.
Hoang VT, Trinh CT, Nguyen CH, Chansomphou V, Chansomphou V, Tran TTT. Overview of epidermoid cyst. Eur J Radiol Open. 2019;6:291-301.
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.
Yuan WH, Hsu HC, Lai YC, Chou YH, Li AF. Differences in sonographic features of ruptured and unruptured epidermal cysts. J Ultrasound Med. 2012;31(2):265-272.
Patel S, Shah S, Patel V. Rare Presentation of Subcutaneous Fat Necrosis at Multiple Sites with Unclear Etiology: A Case Report. J Orthop Case Rep. 2022;12(6):78-81.
Chan LP, Gee R, Keogh C, Munk PL. Imaging features of fat necrosis. AJR Am J Roentgenol. 2003;181(4):955-959.
Walsh M, Jacobson JA, Kim SM, Lucas DR, Morag Y, Fessell DP. Sonography of fat necrosis involving the extremity and torso with magnetic resonance imaging and histologic correlation. J Ultrasound Med. 2008;27(12):1751-1757.
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(3):217-224.
Nair AV, Nazar P, Sekhar R, Ramachandran P, Moorthy S. Morel-Lavallee lesion: A closed degloving injury that requires real attention. Indian J Radiol Imaging. 2014;24(3):288-290.
Tomita H, Yamashiro T, Ikeda H, Fujikawa A, Kurihara Y, Nakajima Y. Fluid collection in the retropharyngeal space: A wide spectrum of various emergency diseases. Eur J Radiol. 2016;85(7):1247-1256.
Davis DD, Kane SM. Muscular Hematoma. In: StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Steven Kane declares no relevant financial relationships with ineligible companies.2023.
Wicks JD, Silver TM, Bree RL. Gray scale features of hematomas: an ultrasonic spectrum. AJR Am J Roentgenol. 1978;131(6):977-980.
Yoon ES, Lin B, Miller TT. Ultrasound of Musculoskeletal Hematomas: Relationship of Sonographic Appearance to Age and Ease of Aspiration. AJR Am J Roentgenol. 2021;216(1):125-130.
Ryu JK, Jin W, Kim GY. Sonographic appearances of small organizing hematomas and thrombi mimicking superficial soft tissue tumors. J Ultrasound Med. 2011;30(10):1431-1436.
Russell G, Navale P, Ludwig DR, Strnad BS, Itani M. Peripheral nodular enhancement in adrenal and renal hematomas: A report of 3 cases. Radiol Case Rep. 2023;18(10):3371-3375.
Russell FM, Rutz M, Rood LK, McGee J, Sarmiento EJ. Abscess Size and Depth on Ultrasound and Association with Treatment Failure without Drainage. West J Emerg Med. 2020;21(2):336-342.
O'Rourke K, Kibbee N, Stubbs A. Ultrasound for the Evaluation of Skin and Soft Tissue Infections. Mo Med. 2015;112(3):202-205.
Arslan H, Sakarya ME, Bozkurt M, Unal O, Dilek ON, Harman M. The role of power Doppler sonography in the evaluation of superficial soft tissue abscesses. Eur J Ultrasound. 1998;8(2):101-106.
Giard MC, Pineda C. Ganglion cyst versus synovial cyst? Ultrasound characteristics through a review of the literature. Rheumatol Int. 2015;35(4):597-605.
Hirji Z, Hunjun JS, Choudur HN. Imaging of the bursae. J Clin Imaging Sci. 2011;1:22.
Ivanoski S, Nikodinovska VV. Sonographic assessment of the anatomy and common pathologies of clinically important bursae. J Ultrason. 2019;19(78):212-221.
Khodaee M. Common Superficial Bursitis. Am Fam Physician. 2017;95(4):224-231.
Abreu E, Aubert S, Wavreille G, Gheno R, Canella C, Cotten A. Peripheral tumor and tumor-like neurogenic lesions. Eur J Radiol. 2013;82(1):38-50.
Jacobson JA, Wilson TJ, Yang LJ. Sonography of Common Peripheral Nerve Disorders With Clinical Correlation. J Ultrasound Med. 2016;35(4):683-693.
Ryu JA, Lee SH, Cha EY, Kim TY, Kim SM, Shin MJ. Sonographic Differentiation Between Schwannomas and Neurofibromas in the Musculoskeletal System. J Ultrasound Med. 2015;34(12):2253-2260.
Walczak BE, Johnson CN, Howe BM. Myositis Ossificans. J Am Acad Orthop Surg. 2015;23(10):612-622.
Kunimoto K, Yamamoto Y, Jinnin M. ISSVA Classification of Vascular Anomalies and Molecular Biology. Int J Mol Sci. 2022;23(4).
Olsen KI, Stacy GS, Montag A. Soft-tissue cavernous hemangioma. Radiographics. 2004;24(3):849-854.
Inarejos Clemente EJ, Diaz Leyva J, Karakas SP, Duarte AM, Mas TR, Restrepo R. Radiologic and Clinical Features of Infantile Hemangioma: Potential Pitfalls and Differential Diagnosis. Radiographics. 2023;43(11):e230064.
Mittal A, Anand R, Gauba R, Choudhury SR, Abbey P. A Step-by-Step Sonographic Approach to Vascular Anomalies in the Pediatric Population: A Pictorial Essay. Indian J Radiol Imaging. 2021;31(1):157-171.
Legiehn GM, Heran MK. Classification, diagnosis, and interventional radiologic management of vascular malformations. Orthop Clin North Am. 2006; 37(3):435–474, vii-viii.
Moukaddam H, Pollak J, Haims AH. MRI characteristics and classification of peripheral vascular malformations and tumors. Skeletal Radiol. 2009;38(6):535-547.
Alfageme Roldan F, Salguero Fernandez I, Zamanta Munoz Garza F, Roustan Gullon G. Update on the Use of Ultrasound in Vascular Anomalies. Actas Dermosifiliogr. 2016;107(4):284-293.
Miceli A, Stewart KM. Lymphangioma. In: StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Kristen Stewart declares no relevant financial relationships with ineligible companies.2023.
Kapoor R, Saha MM, Talwar S. Sonographic appearances of lymphangiomas. Indian Pediatr. 1994;31(11):1447-1450.
McCormack L, Jones K, Huang JT. Micro- and Macrocystic Lymphatic Malformation. J Pediatr. 2020;219:275-276.
Li J, Zhong W, Geng X, et al. Ultrasonographic diagnosis, classification, and treatment of cervical lymphatic malformation in paediatric patients: a retrospective study. BMC Pediatr. 2020;20(1):441.
Restrepo R. Multimodality imaging of vascular anomalies. Pediatr Radiol. 2013;43 Suppl 1:S141-154.
Corvino A, Catalano O, de Magistris G, et al. Usefulness of doppler techniques in the diagnosis of peripheral iatrogenic pseudoaneurysms secondary to minimally invasive interventional and surgical procedures: imaging findings and diagnostic performance study. J Ultrasound. 2020;23(4):563-573.
Peters S, Braun-Dullaeus R, Herold J. Pseudoaneurysm. Hamostaseologie. 2018;38(3):166-172.
Bujoreanu I, Gupta V. Anatomy, Lymph Nodes. In: StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Vikas Gupta declares no relevant financial relationships with ineligible companies.2023.
Maini R, Nagalli S. Lymphadenopathy. In: StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Shivaraj Nagalli declares no relevant financial relationships with ineligible companies.2023.
Ahuja AT, Ying M, Ho SY, et al. Ultrasound of malignant cervical lymph nodes. Cancer Imaging. 2008;8(1):48-56.
Dudea SM, Lenghel M, Botar-Jid C, Vasilescu D, Duma M. Ultrasonography of superficial lymph nodes: benign vs. malignant. Med Ultrason. 2012;14(4):294-306.
Sim JK, Lee JY, Hong HS. Differentiation Between Malignant and Benign Lymph Nodes: Role of Superb Microvascular Imaging in the Evaluation of Cervical Lymph Nodes. J Ultrasound Med. 2019;38(11):3025-3036.
Elsholtz FHJ, Asbach P, Haas M, et al. Introducing the Node Reporting and Data System 1.0 (Node-RADS): a concept for standardized assessment of lymph nodes in cancer. Eur Radiol. 2021;31(8):6116-6124.
Dialani V, James DF, Slanetz PJ. A practical approach to imaging the axilla. Insights Imaging. 2015;6(2):217-229.
Hemachandran N, Goyal A, Kandasamy D, Gamanagatti S, Srivastava DN, Ansari MT. Myotendinous pseudomasses: an imaging review. Acta Radiol. 2023;64(1):172-186.
Chatterjee D, Ing RJ, Gien J. Update on Congenital Diaphragmatic Hernia. Anesth Analg. 2020;131(3):808-821.
Catalano O, Varelli C, Sbordone C, et al. A bump: what to do next? Ultrasound imaging of superficial soft-tissue palpable lesions. J Ultrasound. 2020;23(3):287-300.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Awali, M., Middleton, W.D., Daggumati, L. et al. Ultrasound of palpable lesions: a pictorial review. Abdom Radiol (2024). https://doi.org/10.1007/s00261-024-04249-0
Received:
Revised:
Accepted:
Published:
DOI: https://doi.org/10.1007/s00261-024-04249-0