Korean J Radiol.  2020 Mar;21(3):341-355. 10.3348/kjr.2019.0343.

Ultrasonography of Pediatric Superficial Soft Tissue Tumors and Tumor-Like Lesions

• Kim HW
• Yoo SY
• Oh S
• Jeon TY
• Kim JH

• KMID: 2470758
• DOI: http://doi.org/10.3348/kjr.2019.0343

Abstract

Ultrasonography (US) is usually the first imaging examination performed to evaluate palpable or visible superficial soft tissue lesions that are common in children. Although clinical assessments, such as age at presentation, clinical course, and overlying skin discoloration, are important for the differentiation of pediatric soft tissue lesions, US allows a specific diagnosis of some typical benign lesions and helps in guiding further investigation since it provides detailed information about the lesion location, characterization including solid versus cystic, vascularity, and compressibility. Therefore, sufficient knowledge of the normal anatomy, proper ultrasonographic techniques, and the imaging findings of common and uncommon soft tissue lesions in children are crucial for accurate assessment and management of patients. In this article, we review the techniques and imaging findings focusing on the ultrasonographic features of a variety of superficial soft tissue lesions detected in children.

Keyword

Ultrasonography; MRI; Soft-tissue lesion; Soft-tissue tumor; Children

MeSH Terms

Child
Diagnosis
Humans
Magnetic Resonance Imaging
Skin
Ultrasonography*

Figure

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  Fig. 1 Visualization of normal soft tissue structure at dorsal aspect of forearm by US. US = ultrasonograpy

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  Fig. 2 Infantile hemangioma in 8-month-old girl with enlarging foot mass. US (A) shows well-defined ovoid hypoechoic mass confined to subcutaneous fat. Color Doppler scan (B) shows increased vascular flow.

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  Fig. 3 Congenital hemangioma in 2-day-old boy at knee present at birth. US (A) shows homogeneous hypoechoic lesion in subcutaneous fat layer (arrows). Color Doppler scan (B) shows markedly increased vascular flow.

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  Fig. 4 Lobular capillary hemangioma in 13-year-old girl with enlarging soft tissue mass at scalp. US (A) shows well-defined slightly heterogeneous hypoechoic nodule on skin and subcutaneous fat layer (arrows). Color Doppler scan (B) shows increased vascular flow within nodule.

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  Fig. 5 Kaposiform hemangioendothelioma at right thigh in 2-day-old girl with Kasabach-Merritt phenomenon. US (A) shows large ill-defined heterogeneous mass, which infiltrates subcutaneous tissue and underlying musculature with marked skin thickening. Color Doppler scan (B) shows increased vascular flow with high velocity of lesion. Coronal fat-suppressed T2-weighted MRI (C) shows heterogeneous high signal intensity mass (arrow). Contrast-enhanced coronal fat-suppressed T1-weighted MRI (D) shows prominent enhancement of mass (arrow).

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  Fig. 6 Venous malformation in 9-year old boy presented with mass in hand. US (A) shows inter-/intra-muscular lesion containing anechoic serpentine structure (arrows) with increased internal echogenicity due to slow blood flow. There is focal hyperechoic lesion with posterior acoustic shadowing, suggesting phlebolith (arrowhead). Color Doppler scan (B) shows venous flow.

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  Fig. 7 Lymphatic malformation in 9-year-old girl with palpable mass at wrist dorsum. US (A) shows multiloculated cyst (between cursors) in subcutaneous fat layer with internal septa (arrows) and some echogenic debris. Axial fat-suppressed T2-weighted image (B) shows multiloculated cyst with internal septa.

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  Fig. 8 Lipoma in 9-month-old girl with lump on back. US shows ill-defined ovoid hyperechoic mass (arrows) confined within right paravertebral muscle.

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  Fig. 9 Lipoblastoma in 5-month-old girl with gradually enlarging buttock mass from birth. US (A) shows heterogeneous, mainly hyperechoic mass (arrows), with intervening hypoechoic areas. Axial T1-weighted MRI (B) shows well-demarcated high signal intensity mass (arrows) involving gluteus muscle and subcutaneous fat. There are some intervening hyperintense strands (arrowheads). Axial fat-suppressed T2-weighted MRI (C) shows mainly high signal intensity mass (arrows) with intervening linear hypointense strands suggesting fat component (arrowheads).

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  Fig. 10 Subcutaneous fat necrosis of newborn in 1-month-old boy with small palpable mass at posterior neck. US shows homogeneous echogenic nodule (between cursors) at subcutaneous fat layer without cystic changes or calcification.

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  Fig. 11 Nodular fasciitis in 14-year-old boy on back. US (A) shows well-defined ovoid hypoechoic lesion confined within muscle abutting fascia. Color Doppler scan (B) shows mild peripheral vascularity. Sagittal T2-weighted MRI (C) shows well-demarcated ovoid high signal intensity mass (arrow) within back muscle. Contrast-enhanced sagittal T1-weighted MRI (D) shows diffuse enhancement of mass (arrow) with fascial tail sign (arrowhead).

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  Fig. 12 Fibrous hamartoma of infancy in 8-month-old boy with slowly growing palpable lump at upper arm. US shows well-defined heterogeneous lesion (arrows) with alternating hyperechoic and hypoechoic areas.

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  Fig. 13 Infantile myofibromatosis in neonate presented with multiple palpable lesions. US (A, B) shows well-defined intramuscular hypoechoic mass with minimal peripheral vascularity at forearm. Additional lesions with similar characteristic were also founded at chest wall and buttock on US (not shown). Coronal fat-suppressed T2-weighted MRI (C) shows heterogeneous hyperintense mass with central fluid signal suggesting central necrosis. Contrast-enhanced coronal T1-weighted MRI (D) shows peripheral rim enhancement of lesion.

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  Fig. 14 Plexiform neurofibroma in 14-year-old girl with known neurofibromatosis type 1 and palpable masses on upper arm. US (A) shows conglomerated numerous serpiginous hypoechoic lesions at subcutaneous fat layer and muscle. Coronal T2-weighted MRI (B) shows conglomerated rounded hyperintense lesions with hypointense central foci known as “target sign” (arrows).

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  Fig. 15 Giant cell tumor of tendon sheath in 9-year-old girl with palpable mass at finger. US shows well-defined hypoechoic ovoid mass with lobulated contour at volar aspect of metacarpophalangeal joint, in close contact with but being separate from flexor tendon (arrows).

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  Fig. 16 Epidermal inclusion cyst in 4-year-old boy with palpable mass at chest wall. US shows well-demarcated, ovoid, hypoechoic lesion with posterior acoustic enhancement (arrow).

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  Fig. 17 Ruptured epidermal inclusion cyst in 13-year-old girl at buttock. US (A) shows irregular low echoic nodular lesion with adjacent fat inflammation. Color Doppler scan (B) shows peripheral vascularity

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  Fig. 18 Pilomatricoma in 6-year-old girl with small palpable nodule at pre-auricular area. US (A) shows well-defined ovoid solid lesion (arrows) at subcutaneous fat layer abutting dermis. Lesion shows heterogeneous echogenicity with echogenic calcified foci and increased perilesional fat echogenicity. Color Doppler scan (B) shows peripheral and central vascularity.

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  Fig. 19 Ganglion in 8-year-old girl at hand dorsum. US shows well-defined ovoid hypoechoic mass (arrows).

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  Fig. 20 Rhabdomyosarcoma in 11-month-old girl at foot dorsum. US (A) demonstrates well-circumscribed, lobulating contoured, heterogeneous mass (arrows) at foot dorsum. Color Doppler scan (B) shows increased intralesional vascularity. Metastatic lymphadenopathy has found on US of left inguinal region (not shown). Coronal T2-weighted MRI (C) shows lobulated hyperintense mass (arrow). Contrast-enhanced coronal T1-weighted MRI (D) shows diffuse enhancement of lesion (arrow). Findings are not specific and histopathological findings were needed for final diagnosis.

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  Fig. 21 Synovial sarcoma in 9-year-old girl at forearm. US (A) shows elliptical heterogeneous hypoechoic mass within muscle. Sagittal fat-suppressed T2-weighted MRI (B) shows well-demarcated ovoid hyperintense mass. Contrast-enhanced axial T1-weighted MRI (C) shows prominent enhancement of mass.

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  Fig. 22 Infantile fibrosarcoma in 1-month-old boy at abdominal wall. US (A) shows well-demarcated ovoid hypoechoic mass at subcutaneous fat layer. Color Doppler scan (B) shows slightly increased vascularity of mass. Contrast-enhanced CT scan which was taken 5 months later (C) shows markedly increased size of mass with heterogeneous enhancement (arrows).

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  Fig. 23 Subcutaneous panniculitis-like T-cell lymphoma in 13-year-old boy with enlarging periumbilical mass. US (A) shows diffuse ill-defined hyperechoic lesion at subcutaneous fat layer with multiple linear hypoechoic mass. Color Doppler scan (B) shows increased vascularity within area. Subsequent contrast-enhanced CT (C) shows multiple enhancing nodular infiltrations at subcutaneous layer (arrows).

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  Fig. 24 Metastatic lesions in 3-year-old boy with adrenal neuroblastoma. US (A) shows lobulated hypoechoic solid masses at chest wall with minimal vascularity (arrows). Abdominal US (B) shows primary tumor in left adrenal gland, neuroblastoma (arrows).

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