J Korean Soc Radiol.  2019 Mar;80(2):283-293. 10.3348/jksr.2019.80.2.283.

Superficially Palpable Masses of the Scalp and Face: A Pictorial Essay

• Kim HS
• An JK
• Woo JJ
• Yoon RG

• KMID: 2442519
• DOI: http://doi.org/10.3348/jksr.2019.80.2.283

Abstract

Palpable lesions of the scalp and face are common in clinical practice. They are usually small and benign, and the lesions tend to be treated simply according to the clinical symptoms. However, radiologic evaluation is often performed to determine the exact type and location of a lesion to ensure appropriate management. Ultrasonography is useful as a primary and definitive modality for evaluating small superficial lesions. CT and MRI are better for characterizing soft tissue features and provide superior soft tissue resolution. This article discusses various lesions and their imaging findings of the scalp and face that may present as superficially palpable masses.

MeSH Terms

Magnetic Resonance Imaging
Palpation
Scalp*
Tomography, X-Ray Computed
Ultrasonography

Figure

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  Fig. 1 Epidermal cysts on ultrasonography, CT, and MRI. A. Sonogram shows an oval shaped, heterogeneous, hypoechoic mass with posterior acoustic enhancement arising from the dermal layer. B. Post-contrast CT scans show a well-defined, oval, hypo-attenuated mass in the left cheek abutting into and pushing the overlying skin. There is no enhancement on the post-contrast study (arrow). C, D. T1 (C) and T2 (D)-weighted axial MRI show a well circumscribed oval mass with high signal intensity in the right supraorbital area (arrows).

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  Fig. 2 Pilomatricomas on ultrasonography and CT. A. Sonogram shows three different pilomatricomas: a well-defined oval isoechoic mass with internal hyperechoic spots and small pit (arrowhead) (upper), a parallel heterogeneously hypoechoic mass with internal calcifications (middle), a dense calcified lesion with strong posterior shadowing (lower). B. Pre-contrast CT scan shows a small, oval, calcified lesion in the subcutaneous layer of the right cheek (arrow).

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  Fig. 3 Hemangioma in a 37-year-old man. A. Sonogram shows an ill-defined, irregular, heterogeneous, hypoechoic mass involving the cutaneous layer of the left lower eyelid. B. The mass shows inner vascularity on a color Doppler study.

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  Fig. 4 Branchial cleft cysts on ultrasonography and CT. A. Sonogram shows an oval hypoechoic mass with internal debris and posterior acoustic enhancement in the subcutaneous layer. B. Pre-contrast CT scan shows a well-defined oval mass in the cutaneous layer of the right preauricular area. The mass shows slightly low attenuation compared to muscle (arrow). C. Post-contrast CT scan shows no enhancement of the mass (arrow).

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  Fig. 5 Lipomas on ultrasonography and CT. A. Sonogram shows an approximately 2 cm lentiform, striated, hyperechoic mass in the muscle layer. B. Another elliptical and striated hyperechoic mass is located in the sub-galeal layer of the right temporal area, which was confirmed to be a fibrolipoma. C. Post-contrast CT scan shows a circumscribed oval fatty mass in the muscle layer of the right temporal area (arrow).

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  Fig. 6 Osteomas on ultrasonography and CT. A. Sonogram shows a protruding bony mass with posterior shadowing on the forehead. B. Pre-contrast CT scan demonstrates a circumscribed bony mass in the frontal area of the skull (arrow).

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  Fig. 7 Pleomorphic adenomas on ultrasonography, CT, and MRI. A. Sonogram shows a circumscribed, lobular, heterogeneous, hypoechoic mass deep in the left parotid gland. B. Pre-contrast CT scan shows a slightly low attenuated mass in the left parotid gland (arrow). C. Post-contrast CT scan shows a well-defined lobulated mass with heterogeneous enhancement in the left parotid gland (arrow). D. Another mass of the right parotid gland shows a well-defined lobular shape with intermediate signal intensity on T1-weighted MRI (arrow). E. Post-contrast T1-weighted fat saturated axial MRI shows heterogeneous strong enhancement of the mass (arrow).

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  Fig. 8 Warthin's tumor in a 81-year-old-woman. A. Sonogram shows a well-circumscribed, heterogeneous, hypoechoic mass in the left parotid gland with internal anechoic portions. B. Color Doppler study shows increased inner and peripheral blood flow of the mass. C. Pre-contrast axial CT scan shows a well-defined round mass in the left parotid gland with isoattenuation compared to adjacent muscle (arrow). D. Post-contrast axial CT scan shows heterogeneous internal enhancement with irregular non-enhancing portions (arrow).

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  Fig. 9 Mucoepidermoid carcinoma in a 65-year-old-woman. A. Sonogram shows an approximately 1.5 cm, oval, heterogeneous, hypoechoic mass with an irregular margin in the superficial lobe of the left parotid gland. B. Some peripheral blood flow is seen on a color Doppler study.

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  Fig. 10 Carcinoma ex pleomorphic adenoma in a 69-year-old-man. A. T1-weighted axial MRI shows a large lobulated mass of the left parotid gland with intermediate and slightly high signal intensities (arrow). B. Fat-suppressed T2-weighted axial MRI shows heterogeneous low to high signal intensity of the mass (arrow). C. Post-contrast fat-suppressed T1-weighted axial image shows heterogeneous strong enhancement of the mass with tumor necrosis (arrow). Tumor invasion is noted in the left masticator space and retromastoid soft tissue.

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