Ultrasound Q&A Review for the Boards by Adrian Dawkins;

Author:Adrian Dawkins;
Language: eng
Format: epub
Publisher: Thieme Medical Publishing Inc.
Published: 2020-07-15T00:00:00+00:00

Question 6.19: Based on the images what is the most likely diagnosis?

A. Ganglion.

B. Lipoma.

C. Lymph node.

D. Soft-tissue sarcoma.

E. Nerve sheath tumor.

Question 6.20: What do the vertical arrows indicate?

A. Fat.

B. Muscle.

C. Vessel.

D. Nerve.

E. Fascia.

Question 6.21: What is the most common soft-tissue tumor?

A. Angiolipoma.

B. Lipoma.

C. Lipoblastoma.

D. Liposarcoma.

E. Hibernoma.

Answer 6.19:

E. Correct. A nerve sheath tumor is a solid soft-tissue mass that is in continuity with a peripheral nerve. These masses are typically hypoechoic and may have low-level internal echoes. They are round or oval and are well defined. The mass often will have increased through transmission, as this example does, which may cause it to be mistaken for a cyst. However, color or power Doppler imaging will demonstrate internal vascularity which will distinguish it from a cyst.

A. Incorrect. A ganglion is a cystic mass, however they will not have internal vascularity as the mass in this case does.

B. Incorrect. A lipoma may be present within the subcutaneous tissues or within a muscle. The echogenicity may vary depending on the location of the mass, either within the subcutaneous tissues or within a muscle, and the amount of fibrous tissue within the mass. Lipomas within a muscle or those which have more fibrous tissue will appear hyperechoic. The example in this case, however, is more hypoechoic and more round than is typical of a lipoma.

C. Incorrect. Lymph nodes are typically reniform in shape with a fatty echogenic hilum. Blood flow to the lymph node is usually through the hilum. The cortex is hypoechoic. The example in this case is not compatible with a normal lymph node.

D. Incorrect. Soft-tissue sarcomas are typically hypoechoic. They may have areas which are anechoic due to necrosis within the mass. They have increased vascularity on color or power Doppler imaging and have increased posterior through transmission. They, however, are not in continuity with a nerve.

Answer 6.20:

D. Correct. The vertical arrows point to the nerve as it enters and exits the mass. This is characteristic of a nerve sheath tumor.

A. Incorrect. The subcutaneous fat within the images is superficial to the mass.

B. Incorrect. No muscle is noted within the images.

C. Incorrect. Small vessels are noted within the col- or Doppler image; however, these are not depicted by the vertical arrows.

E. Incorrect. No fascia is noted within the images.

Answer 6.21:

B. Correct. Lipomas are the most common soft-tissue tumors, accounting for approximately 50% of all soft-tissue tumors. They occur most commonly in the fifth through seventh decades of life. They are composed of mature adipose tissue and they resemble subcutaneous fat. They may have a few thin septa, less than 2 mm in thickness.

A. Incorrect. Angiolipoma is a benign neoplasm which presents in the second or third decade of life as multiple, small, tender, subcutaneous nodules within the forearm, upper arm, or trunk.

C. Incorrect. Lipoblastoma is a rare neoplasm of childhood, typically occurring in children less than 3 years of age. They most commonly occur in the extremities as a painless, enlarging mass.

D. Incorrect. Liposarcomas account for approximately 17% of all soft-tissue sarcomas. They usually present in the sixth decade of life as a painless, enlarging mass.

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