Ultrasound and Doppler US in Evaluation of Superficial Soft-tissue Lesions

Abstract

Improved developments in digital ultrasound technology and the use of high-frequency broadband transducers make ultrasound (US) imaging the first screening tool in investigating superficial tissue lesions. US is a safe (no ionizing radiation), portable, easily repeatable, and cheap form of imaging compared to other imaging modalities. US is an excellent imaging modality to determine the nature of a mass lesion (cystic or solid) and its anatomic relation to adjoining structures. Masses can be characterized in terms of their size, number, component, and vascularity with US and Doppler US especially with power Doppler US. US, however, is operator dependent and has a number of artifacts that can result in misinterpretation. In this review, we emphasize the role of ultrasound, particularly power Doppler, in superficial soft-tissue lesions.

Keywords: Doppler; lesion; soft tissue; ultrasound.

Figure 1

Avascular Baker's cyst in popliteal fossa. Transverse Doppler US image with Toshiba Applio machine (Toshiba Medical Systems, Tokyo, Japan) using 12-MHz probe demonstrates a 3.5 × 2.5 cm cystic mass.

Figure 2

Ganglion cyst in a girl. (a)Transverse US image shows multilobulated anechoic cystic structure (arrows) on the dorsal part of the left wrist. R. distal radius (b) Power Doppler image shows absence of vascularization in the lesion.

Figure 3

Right extensor carpi radialis brevis tendon rupture in patient with Behçet's disease. (a and b) Contiguous transverse and (c) longitudinal extended field of view sonogram images show partial rupture and hematoma (arrow). (I, II, III; normal appearing other tendons).

Figure 4

Patient with Brucellosis. (a) Transverse sonogram shows 2 × 1 cm septated complex cystic mass (arrows) adjacent to 6th anterior rib (R). (b) Power Doppler image shows prominent flow around the lesion.

Figure 5

Right submandibular abscess. (a) Longitudinal sonogram shows 1 × 0.5 cm heterogeneous mass containing thick hyperechoic wall and septae in right submandibular gland (M). (b) Power Doppler image shows prominent flow around the lesion.

Figure 6

Cellulitis at right femoral region. Transverse sonogram shows thickening of subcutaneous tissues and increase in echogenicity.

Figure 7

Tenosynovitis in left wrist. (a) Longitudinal sonogram shows hyopoechoic mass around the flexor carpi ulnaris tendon (T) and (b) power Doppler images show vascularization in and around the lesion.

Figure 8

Nonspecific tenosynovitis of flexor carpi radialis. (a) Longitudinal and (b) transverse Doppler US images show vascularization in and around the heterogeneous soft tissue mass. There is also extensive synovitis and fluid (f) and around the tendon.

Figure 9

Abdominal wall scar endometriosis. (a) Transverse sonogram shows irregular shaped, hypoechoic solid mass in the subcutanous fat. (b) Power Doppler sonography shows absence of vascularization.

Figure 10

Lipoma. The patient had a painless soft-tissue mass over the right neck. Doppler US shows a 3 × 1 cm soft-tissue mass (arrowheads) within the subcutaneous fat with similar echogenicity to the adjacent fat, without vascularization.

Figure 11

Neurofibroma in a 13-year-old girl. (a) Transverse and (b) longitudinal color Doppler images show hypoechoic solid mass with central vascularization. (c) Spectral Doppler image shows low-resistance arterial flow.

Figure 12

Pilomatricoma. a and b) Transverse sonograms demonstrate a 6 × 4 × 2 cm subcutaneous hyperechoic mass lesion (arrows) with calcifications (arrowheads) at the right shoulder. (c) Color Doppler US demonstrates internal vascularity and (d) spectral Doppler US demonstrates arterial flow in the lesion.

Figure 13

Hemangioma in left thigh. Color Doppler US shows heterogeneous hypoechoic soft tissue mass with prominent vascularization in the subcutaneous area.

Figure 14

Hemangioma. Color Doppler image reveals a highly vascular mass consistent with capillary hemangioma at the superolateral margin of the right orbit.

Figure 15

Basal cell carcinoma. (a and b) Color Doppler and (c) spectral Doppler images show a hypervascular hypoechoic mass lesion with arterial waveform at the right occipital region. Histopathological diagnosis was pigmented basal cell carcinoma.

Figure 16

Skin metastases of gastric carcinoma. (a) Power Doppler image shows irregular shaped, hypoechoic soft tissue mass with internal vascularity. (b) Spectral Doppler US demonstrates arterial flow in the lesion.