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Patel R, Shames A, Sarkodieh J. Ultrasound features of benign paediatric lumps: radiology-pathology correlation. Clin Radiol 2024; 79:255-262. [PMID: 38320943 DOI: 10.1016/j.crad.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 12/12/2023] [Accepted: 12/31/2023] [Indexed: 02/08/2024]
Abstract
Ultrasonography is an appropriate first-line imaging technique for the characterisation of paediatric lumps, given its relative accessibility and absence of radiation exposure. Together with a thorough history and examination, ultrasonography can help to distinguish benign lesions from malignancy. It can also aid further characterisation of benign lesions to inform onward investigation and management. This review features the evaluation of common benign paediatric lumps together with their characteristic sonographic features, following correlation with histopathology results or clinical follow-up.
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Affiliation(s)
- R Patel
- Whipps Cross Hospital, Barts Health NHS Trust, Whipps Cross Road, London, UK.
| | - A Shames
- Whipps Cross Hospital, Barts Health NHS Trust, Whipps Cross Road, London, UK
| | - J Sarkodieh
- Whipps Cross Hospital, Barts Health NHS Trust, Whipps Cross Road, London, UK
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2
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Tzatzairis T, Skarentzos K, Grammatikos C, Karamalis C, Korakianitis K, Kourempeles R, Drosos G. Ultrasound Applications in Pediatric Orthopedics. THE ARCHIVES OF BONE AND JOINT SURGERY 2024; 12:457-468. [PMID: 39070878 PMCID: PMC11283298 DOI: 10.22038/abjs.2024.59904.2950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 05/11/2024] [Indexed: 07/30/2024]
Abstract
Imaging techniques have significantly impacted physicians' capability for diagnosis and differential diagnosis for decades. The aim of this review is to update our knowledge regarding the use of US in orthopedic pediatric patients for diagnostic purposes or procedural/therapeutic purposes. This review demonstrates the application of US in trauma (long bone fractures, radial neck fractures, etc.), developmental anomalies such as developmental dysplasia of the hip and congenital dislocation of the patella, soft tissue pathologies (ganglion cyst, popliteal cyst, hemangioma, lipoma, etc.), tumors, apophysitis, joint effusion, and femoral acetabular impingement. US aid in musculoskeletal procedures has also been reported; US-guided procedures such as aspiration, injection, biopsy, foreign body removal, and peripheral nerve block reduce complications, thus making the procedures safer for the patient. Sonography is a fast, low-cost, mobile, non-invasive, and radiation-free diagnostic tool. Even though US requires a skilled operator and has a long learning curve, in experienced hands is the "orthopedic surgeon's stethoscope".
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Affiliation(s)
- Themistoklis Tzatzairis
- Department of Orthopaedic Surgery, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Konstantinos Skarentzos
- Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Christos Grammatikos
- Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Charalampos Karamalis
- Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Konstantinos Korakianitis
- Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Romanos Kourempeles
- Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Georgios Drosos
- Department of Orthopaedic Surgery, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
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3
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Hu J, Xia B, Yuan X, Chen H, Ou F, Huang L, Xu L, Feng X. Neuroblastoma with superficial soft tissue mass as the first symptom: case reports with atypical ultrasonic image and literature review. Braz J Med Biol Res 2023; 56:e12975. [PMID: 38088674 PMCID: PMC10712279 DOI: 10.1590/1414-431x2023e12975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023] Open
Abstract
Neuroblastoma is one of the most common tumors in children. Cases where an isolated soft-tissue metastasis mass is the initial symptom are rare, with only four such cases reported to date. We describe the imaging findings of ten cases of neuroblastoma patients in our hospital with superficial soft tissue mass (SSTM) as the primary symptom. The main ultrasound finding of SSTM was hypoechoic masses or scattered speck-like hyperechoic masses. However, when this type of SSTM is caused by soft tissue metastasis, the location is often atypical, and ultrasound findings are difficult to distinguish from other benign diseases. Therefore, this research should remind clinicians to recognize atypical presentations of this common childhood malignant tumor. Radiologists should also consider the possibility of neuroblastoma when finding this type of SSTM with atypical ultrasound features.
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Affiliation(s)
- Jiale Hu
- Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
- China Medical University, Shenyang, Liaoning, China
| | - Bei Xia
- Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Xiuli Yuan
- China Medical University, Shenyang, Liaoning, China
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Haixing Chen
- Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Fuxiang Ou
- Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Longlong Huang
- Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Lei Xu
- Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
- China Medical University, Shenyang, Liaoning, China
| | - Xia Feng
- Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
- China Medical University, Shenyang, Liaoning, China
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4
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Du X, Xia A, Sun J, Ye Y. Localized tenosynovial giant cell tumor in children. J Child Orthop 2023; 17:420-427. [PMID: 37799313 PMCID: PMC10549694 DOI: 10.1177/18632521231186795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/01/2023] [Indexed: 10/07/2023] Open
Abstract
Background To investigate the clinical characteristics and surgical efficacy of localized tenosynovial giant cell tumors in children. Methods The clinical data, surgery, and follow-up results of 17 children with localized tenosynovial giant cell tumors who visited our hospital from 2011 to 2021 were collected for statistical analysis. Results The median patient age was 7 years and 8 months, and the ratio of males to females was 1.43 (10/7). The predilection of disease was similar in hands and feet, and the common presenting symptom was mass. One patient experienced recurrence after surgery, and one child had postoperative functional limitations. Conclusion Extremities are common sites of localized tenosynovial giant cell tumors in children. Complete surgical resection helps reduce the recurrence rate. Level of evidence Level III.
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Affiliation(s)
| | - Anning Xia
- Anning Xia, Department of Orthopedics, Shenzhen Children’s Hospital, No. 7019 Yitian Road, Futian District, Shenzhen 518000, Guangdong, China.
| | - Junying Sun
- Department of Orthopedics, Shenzhen Children’s Hospital, Shenzhen, China
| | - Yinting Ye
- Department of Orthopedics, Shenzhen Children’s Hospital, Shenzhen, China
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5
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Wang Y, Guo W, Ma B, Li T, Yan X, Wang Y, Yan Z. Two cases of hemangioma with Kasabach-Merritt phenomenon diagnosed via ultrasound. Quant Imaging Med Surg 2023; 13:6305-6309. [PMID: 37711829 PMCID: PMC10498253 DOI: 10.21037/qims-23-81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/07/2023] [Indexed: 09/16/2023]
Affiliation(s)
- Yanzhao Wang
- Department of Ultrasound Diagnosis, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Wenjing Guo
- Department of Ultrasound Diagnosis, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Bin Ma
- Department of Ultrasound Diagnosis, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Tiangang Li
- Department of Ultrasound Diagnosis, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Xide Yan
- Department of Ultrasound, The First People’s Hospital of Xining, Xining, China
| | - Yixuan Wang
- Department of Ultrasound Diagnosis, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Zhiheng Yan
- Department of Ultrasound Diagnosis, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
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6
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Malek D, Alam H, Luo L, Hong A, Edison M. Dermatofibrosarcoma Protuberans Presenting as a Primary Breast Mass. Cureus 2023; 15:e46052. [PMID: 37900364 PMCID: PMC10604421 DOI: 10.7759/cureus.46052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is an atypical soft tissue malignancy that affects the dermis and subcutaneous tissue. The cause of DFSP is not clearly understood. This report highlights a rare case of DFSP of the left breast. We report a case of an 18-year-old female with past medical history of type 1 diabetes mellitus, who presented to the breast imaging clinic with a six-month history of left breast lump and associated skin discoloration. The patient had a dedicated left breast ultrasound which showed an indistinct, oval, hyperechoic mass in the superficial breast, measuring 1.4 x 1.0 x 2.5 cm with mild internal vascularity. An ultrasound-guided biopsy of this left breast mass was recommended and performed approximately three weeks later, demonstrating DFSP. The patient was then advised for consultation with Oncology, Surgical Oncology, and Radiation Oncology, to which surgical excision was the final recommendation. The patient had a wide local surgical excision procedure for her left breast mass with surgical pathology confirming negative margins shortly thereafter. This case highlights a great index of suspicion that should be taken when evaluating palpable breast masses with associated skin discoloration in young patients.
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Affiliation(s)
| | - Harris Alam
- Radiology, AdventHealth Orlando, Orlando, USA
| | - Lin Luo
- Radiology, AdventHealth Orlando, Orlando, USA
| | - Andrea Hong
- Radiology, AdventHealth Orlando, Orlando, USA
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7
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Wortsman X. Key Points to Select a Device for Dermatologic Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:521-545. [PMID: 36394307 DOI: 10.1002/jum.16000] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 05/26/2023]
Abstract
What points to consider when selecting a device for practicing dermatologic ultrasound is an excellent question. After we met the requisites published in the guidelines for practicing dermatologic ultrasound, it is necessary to consider the main objective of the use because it is not the same to be focused mostly on the avoidance of the puncture of important facial vessels such as the case of injectors of cosmetic fillers in comparison to the use of operators that need to deal with the diagnosis and monitoring of a wide range of dermatologic pathologies. Currently, a broad variety of ultrasound devices meets the minimum requirements for practicing these examinations in the market. Thus, small, portable, and high-end devices may present advantages and limitations that must be balanced according to the primary purposes and the budget. Moreover, the shape and footprint of the probes can make difficult or facilitate a dermatologic procedure. Other points to consider are the type of storage and the need for technical service. In summary, there are key points that we need to consider when we select a dermatologic ultrasound device in dermatology or aesthetics.
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Affiliation(s)
- Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile
- Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
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8
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Zhang YL, Ma Q, Hu Y, Wu MJ, Wei ZK, Yao QY, Li JM, Li A. Analysis on diagnostic failure of US-guided core needle biopsy for soft tissue tumors. RESEARCH IN DIAGNOSTIC AND INTERVENTIONAL IMAGING 2023; 5:100023. [PMID: 39076167 PMCID: PMC11265195 DOI: 10.1016/j.redii.2023.100023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/27/2022] [Indexed: 07/31/2024]
Abstract
Purpose To evaluate the diagnostic yield of ultrasonography (US)-guided core needle biopsy (CNB) in the diagnosis of soft tissue tumors (STTs) and to analyze the failure factors. Methods 139 patients with STTs that underwent both US-guided CNB and surgical resection were collected retrospectively. Compared with the histopathological results of surgical resection, the biopsy failure was defined as the following conditions: indefinitive diagnosis, including insufficient samples and unknown subtypes with correct biological potential classification; wrong diagnosis, including wrong biological potential classification and wrong subtypes with correct biological potential classification. Univariate and multivariate analyses from the perspectives of histopathological, demographic and US features together with biopsy procedures were performed to determine risk factors for diagnostic failure. Results The diagnostic yield of US-guided CNB for STTs in our study was 78.4%, but when only considering the correct biological potential classification of STTs, the diagnostic yield was 80.6%. The multivariate analysis showed that adipocytic tumors (odds ratio (OR) = 10.195, 95% confidence interval (CI): 1.062 - 97.861, p = 0.044), vascular tumors (OR = 41.710, 95% CI: 3.126 - 556.581, p = 0.005) and indeterminate US diagnosis (OR = 8.641, 95% CI: 1.852 - 40.303, p = 0.006) were correlated with the diagnostic failure. The grade III vascular density (OR = 0.019, 95% CI: 0.001 - 0.273, p = 0.007) enabled a higher diagnostic accuracy. Conclusion US-guided CNB can be an effective modality for the diagnosis of STTs. The diagnostic yield can be increased when the tumor vascular density was grade III in Color Doppler US, but can be decreased in adipocytic tumors, vascular tumors and masses with indeterminate US diagnosis.
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Affiliation(s)
- Ying-Lun Zhang
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Nanjing, Gulou district, China
| | - Qian Ma
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Nanjing, Gulou district, China
| | - Yu Hu
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Nanjing, Gulou district, China
| | - Meng-Jie Wu
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Nanjing, Gulou district, China
| | - Zong-Kai Wei
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Nanjing, Gulou district, China
| | - Qi-Yu Yao
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Nanjing, Gulou district, China
| | - Ju-Ming Li
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Nanjing, Gulou district, China
| | - Ao Li
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Nanjing, Gulou district, China
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9
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Restrepo R, Inarejos Clemente EJ, Corral G, Mas TR, Fenlon EP, Jaramillo D. Subcutaneous fat necrosis of the newborn: a pictorial essay of an under-recognized entity. Pediatr Radiol 2023; 53:313-323. [PMID: 36151218 DOI: 10.1007/s00247-022-05509-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/01/2022] [Accepted: 09/01/2022] [Indexed: 02/04/2023]
Abstract
Subcutaneous fat necrosis of the newborn is a self-limited disorder predominantly affecting full-term and post-term neonates during the first 6 weeks after birth. Subcutaneous fat necrosis can be focal or multifocal and affect one or both sides with a predilection for areas of pressure in certain anatomical areas. Subcutaneous fat necrosis of the newborn is associated with perinatal asphyxia and other neonatal and maternal risk factors. Subcutaneous fat necrosis of the newborn presents as a self-limited area of dermal edema followed by indurated subcutaneous plaques, or nontender and mobile nodules, sometimes with skin discoloration [1-3]. The diagnosis is based on the child's history and physical examination, but when in doubt, imaging is helpful. US is the imaging modality of choice to confirm the diagnosis of subcutaneous fat necrosis of the newborn because it provides the best resolution of superficial lesions, requires no sedation and lacks ionizing radiation. US can also help evaluate and characterize other pathologies affecting the superficial subcutaneous soft tissues at this age. Familiarity with subcutaneous fat necrosis of the newborn is important to make a prompt and precise diagnosis and avoid unnecessary imaging tests or invasive procedures.
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Affiliation(s)
- Ricardo Restrepo
- Department of Radiology, Nicklaus Children's Hospital, Miami, FL, USA
| | | | - Gonzalo Corral
- Department of Radiology, Hospital Exequiel González Cortés, Santiago, Chile
| | - Thomas R Mas
- Ross University School of Medicine, Miramar, FL, USA
| | - Edward P Fenlon
- Department of Radiology, Columbia University Medical Center, 622 West 168th St., New York, NY, 10032, USA
| | - Diego Jaramillo
- Department of Radiology, Columbia University Medical Center, 622 West 168th St., New York, NY, 10032, USA.
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10
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Llanos D, de la Pedraja I, Campos L, Armijo J, Ávila LF. Imaging palpable tumors in pediatrics: Part 2. RADIOLOGIA 2023; 65:43-54. [PMID: 36842785 DOI: 10.1016/j.rxeng.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/03/2022] [Indexed: 02/28/2023]
Abstract
Palpable tumors in children are a common reason for consulting a radiologist. The origin of these lesions varies widely, and although they are common, classic radiology books do not cover some of them. This series of two articles aims to review the clinical and radiological characteristics of a selection of palpable tumors in children that radiologists need to be familiar with.
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Affiliation(s)
- D Llanos
- Servicio de Radiodiagnóstico, Hospital Universitario Clínico San Carlos, Madrid, Spain.
| | - I de la Pedraja
- Servicio de Radiodiagnóstico, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - L Campos
- Servicio de Dermatología, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - J Armijo
- Servicio de Radiodiagnóstico, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - L F Ávila
- Servicio de Cirugía Pediátrica, Hospital Universitario Clínico San Carlos, Madrid, Spain
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11
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Llanos D, de la Pedraja I, Campos L, Armijo J, Ávila L. Radiología de las tumoraciones palpables en el paciente pediátrico. Parte 2. RADIOLOGIA 2023. [DOI: 10.1016/j.rx.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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12
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Myxolipoma of hand in a child: case report of a rare tumor. J Ultrasound 2022; 26:295-300. [PMID: 36152213 PMCID: PMC10063741 DOI: 10.1007/s40477-022-00727-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/31/2022] [Indexed: 10/14/2022] Open
Abstract
Lipomatous tumors account for less than 10% of tumors in the pediatric population. Myxolipomas (a subset of lipoma characterised by mature adipose tissue and abundant mucoid substance) are found to be even rarer. There are a few case reports in different body parts like heart, kidney, oral cavity, epiglottis, cervical and mediastinal regions. However, there are no case reports on the involvement of the hands in any age group. High resolution ultrasound is the imaging modality of choice for the initial evaluation of superficial soft tissue tumors, their site, nature and extent. In conjunction with clinical findings and age of presentation, it helps in narrowing down the differential diagnosis and planning the management. Hyperechoic fatty tumors in the pediatric hand are mostly benign and includes lipomas, lipoblastomas and fibrous hamartomas of infancy as the main differentials. A definitive diagnosis is based on a histo-pathological and molecular cytogenetic examination. This article presents a never before reported case of a rare, large, myxolipoma of the hand in a 22-month-old boy.
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13
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de Borja C, Watkins R, Woolridge T. Common Ultrasound Applications for Pediatric Musculoskeletal Conditions. Curr Rev Musculoskelet Med 2022; 15:447-455. [PMID: 35932426 PMCID: PMC9789252 DOI: 10.1007/s12178-022-09788-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW To discuss the use of ultrasound for diagnosis and management of common pediatric musculoskeletal conditions through a case-based approach. RECENT FINDINGS Ultrasound is an essential diagnostic modality in the early detection of developmental dysplasia of the hips and can be used as early as 6 weeks of age when the ossific nucleus has not developed yet. Ultrasound is helpful in diagnosing traumatic injuries such as fractures and intramuscular hematomas, can visualize fracture healing at early stages, and can also be used to guide aspiration of hematomas that can help with decreasing pain and faster recovery. Ultrasound is superior to radiographs in evaluating joint effusions and soft tissue infections or masses and is better tolerated by children compared to other imaging modalities such as magnetic resonance imaging (MRI). Ultrasound is an easily accessible, affordable, non-invasive, and radiation-free imaging modality that is well tolerated by children and their families. It can aid in the diagnosis and management of a wide variety of musculoskeletal conditions including developmental, traumatic, and infectious etiologies, as well as in the evaluation of superficial soft tissue masses.
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Affiliation(s)
- Celina de Borja
- Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, University of California, San Francisco, 1825 4th Street – 5th Floor, San Francisco, CA 94158 USA
| | - Rhonda Watkins
- Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, University of California, San Francisco, 1825 4th Street – 5th Floor, San Francisco, CA 94158 USA
| | - Tiana Woolridge
- Department of Pediatrics, University of California, San Francisco, San Francisco, USA
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14
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Meyers AB, Epelman M. Ultrasound versus magnetic resonance imaging of soft-tissue lesions: competitive or complementary? Pediatr Radiol 2022; 52:1639-1647. [PMID: 35122484 DOI: 10.1007/s00247-021-05274-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/10/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Abstract
Soft-tissue lumps and bumps are a common referral for imaging in children and adolescents. The etiology of these lesions includes benign non-tumorous lesions, as well as benign and malignant tumors. Some of these lesions have a characteristic imaging appearance but others do not and require tissue sampling to make a diagnosis. MRI typically provides the best overall characterization of soft-tissue masses; however, in some cases US provides complementary information to that provided by MRI that can help make a diagnosis.
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Affiliation(s)
- Arthur B Meyers
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave., Cincinnati, OH, 45229, USA.
| | - Monica Epelman
- Department of Radiology, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL, USA
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15
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Pediatric chest wall masses: spectrum of benign findings on ultrasound. Pediatr Radiol 2022; 52:429-444. [PMID: 34505950 DOI: 10.1007/s00247-021-05196-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/20/2021] [Accepted: 08/18/2021] [Indexed: 12/16/2022]
Abstract
A palpable finding along the chest wall is a frequent indication for pediatric US. Accurate identification of benign lesions can reassure families and appropriately triage children who need follow-up, cross-sectional imaging, or biopsy. In this pictorial essay, we review chest wall anatomy, illustrate US techniques and discuss key US imaging features of common benign lesions and normal variants.
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16
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Scheier E. Abscesses Should Be Both Seen and Heard: The Case for Routine Point-of-Care Ultrasound Before Drainage. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:519-520. [PMID: 33788318 DOI: 10.1002/jum.15709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Eric Scheier
- Pediatric Emergency, Kaplan Medical Center, Rehovot, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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17
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Pušnik L, Šekoranja D, Plut D. A Unique Case of Multicentric Infantile Myofibromatosis with Radiologic-Pathologic Correlation. CHILDREN 2022; 9:children9010053. [PMID: 35053678 PMCID: PMC8774631 DOI: 10.3390/children9010053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/23/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022]
Abstract
Infantile myofibromatosis (IM) is a rare condition with a variable clinical presentation that characteristically affects young children. Most frequently it presents as one or more benign nodules of the skin, bones, soft tissues, or, rarely, visceral organs. According to the location and number of lesions, there are three different forms: solitary, multicentric without visceral involvement, and multicentric with visceral involvement (generalised), with the latter having the least favourable prognosis. We present a unique case of severe congenital generalised IM in a new-born male who required intubation and mechanical ventilation immediately after the birth due to respiratory distress. A chest radiograph showed numerous tumours involving the entire lung, resembling a metastatic lung disease. Additionally, the neonate had multiple, bluish, papular skin nodules and a biopsy of a skin nodule ultimately led to the diagnosis of IM. Diffuse lung involvement prevented adequate ventilation which resulted in multiorgan failure and death before targeted treatment could have been initiated. The presented case is unique, as such atypical extensive involvement of the lung and leptomeninges in IM has not been reported before. In this brief report, we present the findings of radiographic and ultrasonographic examinations in correlation with autopsy and histopathology.
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Affiliation(s)
- Luka Pušnik
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
- Correspondence: ; Tel.: +386-31-573-832
| | - Daja Šekoranja
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Domen Plut
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
- Clinical Radiology Institute, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
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18
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Gaw CE, Turn CS, Rheingold SR, Castelo-Soccio L, Tencer J, Gans AS, Scarfone RJ. Scalp Nodules and Facial Droop in an Infant. Pediatrics 2021; 148:peds.2021-049969. [PMID: 34610947 DOI: 10.1542/peds.2021-049969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 11/24/2022] Open
Abstract
A previously healthy, term, 5-week-old girl initially presented to her primary care physician with a solitary, enlarging scalp nodule. The infant was otherwise well without additional signs or symptoms of illness. Over the next several weeks, the nodule continued to grow, and additional lesions appeared on her scalp. An ultrasound of the primary nodule revealed a hypoechoic structure favored to represent a serosanguinous fluid collection. After evaluation by general surgery and dermatology, she underwent a scalp biopsy of the largest lesion. While biopsy specimen results were pending, her parents noted that she was developing increased irritability, difficulty closing her right eye, and facial weakness. She was referred to the emergency department where a right-sided facial droop involving the brow and forehead was noted. The skin biopsy specimen results, along with subsequent laboratory studies and imaging, led to the final diagnosis.
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Affiliation(s)
| | | | | | | | | | - Anjuli S Gans
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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19
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Zou MH, Huang Q, Yang T, Jiang Y, Zhang LJ, Xie Y, Zheng RQ. Role of ultrasound in the diagnosis of primary and recurrent dermatofibrosarcoma protuberans. BMC Cancer 2021; 21:909. [PMID: 34376150 PMCID: PMC8356448 DOI: 10.1186/s12885-021-08476-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/08/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a rare, low- to intermediate-grade sarcoma, which represents a diagnostic imaging challenge. This study aimed to analyze the clinical and ultrasound features of primary and recurrent DFSP to improve the diagnosis. METHODS Clinical, imaging, and pathological data from a total of 58 patients (23 patients with primary DFSP and 35 patients with recurrent DFSP) were retrospectively reviewed. RESULTS There was no statistically significant difference in age, sex, tumor size, or echogenicity between the two groups. Most of the primary DFSP lesions involved the overlying dermis and hypodermis, while most of the recurrent DFSP lesions were fixated to more deeply seated structures at the original surgical incision. Red nodules on the skin were found more frequently in the primary group. There were statistically significant differences in the type of lesion and ultrasound tumor morphology (p < 0.050). The lesions in the primary group showed more tentacle-like projections or a "claw" sign, while the lesions in the recurrent group were more commonly oval, lobulated, and irregularly shaped. Hypervascularity was common in both groups. CONCLUSIONS For primary DFSP, a slow-growing, red nodule on the skin involving the overlying dermis and hypodermis, more frequently a hypoechoic mass with tentacle-like projections or a "claw" sign, was observed. For recurrent DFSP, palpable subcutaneous nodules or subcutaneous masses at the original surgical incision and oval, lobulated, and irregularly shaped lesions were more commonly observed. This may be useful for improving diagnostic accuracy.
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Affiliation(s)
- Min-Hong Zou
- Department of Ultrasound, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, China
| | - Qing Huang
- Department of General Surgery, Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, The Second Affiliated Hospital of South China University of Technology, Guangzhou, Guangdong, China
| | - Ting Yang
- Department of Nuclear Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ye Jiang
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Luan-Jing Zhang
- Department of Ultrasound, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, China
| | - Yang Xie
- Department of Dermatology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Rong-Qin Zheng
- Department of Ultrasound, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, China.
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20
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Navarro OM. Pearls and Pitfalls in the Imaging of Soft-Tissue Masses in Children. Semin Ultrasound CT MR 2020; 41:498-512. [PMID: 32980096 DOI: 10.1053/j.sult.2020.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
There is a broad spectrum of soft-tissue masses in children that can be challenging to diagnose clinically and on imaging. This article reviews the typical clinical and imaging findings of the most common and relevant benign, intermediate and malignant pediatric soft-tissue tumors in the following categories of the 2013 World Health Organization (WHO) classification: adipocytic tumors (lipoma, lipoblastoma, and liposarcoma), fibroblastic/myofibroblastic tumors (nodular fasciitis, myositis ossificans, fibrous hamartoma of infancy, fibromatosis colli, desmoid-type fibromatosis, lipofibromatosis, and infantile fibrosarcoma), pericytic tumors (myofibroma/myofibromatosis), skeletal muscle tumor (rhabdomyosarcoma), nerve sheath tumors (neurofibroma, malignant peripheral nerve sheath tumor), and uncertain differentiation (synovial sarcoma). In general, ultrasound and magnetic resonance imaging are used as first- and second-line imaging modalities, with limited roles for plain radiographs, computed tomography, and fluorodeoxyglucose-positron emission tomography. Many of these tumors have nonspecific imaging findings although there are some key imaging clues that in conjunction with the clinical information allow a specific diagnosis or a narrow differential diagnosis. However, in many instances, histology is required for final diagnosis.
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Affiliation(s)
- Oscar M Navarro
- Department of Medical Imaging, University of Toronto, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada.
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