Subcutaneous Abdominal Wall Masses: Radiological Reasoning

Abstract

Integrating salient imaging findings with clinical history is crucial when approaching the diagnosis of subcutaneous soft-tissue masses. The diagnosis of endometriosis should be entertained when soft-tissue masses are seen in the distribution of a cesarean section scar in a woman of reproductive age. Pain, particularly with a cyclic pattern, is highly suggestive of endometriosis. If endometriosis is suspected on CT or ultrasound, MRI can be performed for further evaluation. Definitive diagnosis is made with biopsy. Because subcutaneous nodules are so amenable percutaneous biopsy, imaging features, although of interest, are somewhat ancillary to the diagnostic workup.

Abdominal Wall Endometrioma: Ultrasonographic Features and Correlation with Clinical Findings

“…Larger lesions extend deeper and feed from the rich vasculature of the rectus sheath (via deep branches of inferior and superior epigastric arteries). However, small lesions are located in hypovascular subcutaneous fat, thus their growth is limited (13)(14)(15). In the presence of a rapidly growing, painless mass and the absence of previous surgery, malignant soft tissue masses in the abdominal wall should be considered in the imaging differential diagnosis.…”

“…Furthermore, it is insufficient for specific diagnosis. AWE cannot be distinguished from invasive abdominal masses by CT (12,14,17). Although, typically, MRI is suited best for defining the anatomy of the soft tissue mass and its surrounding structures, the signal characteristics and contrast enhancement pattern of AWE are not specific, and the true histological nature of the tumour or other soft-tissue masses often cannot be ascertained by imaging alone, with few exceptions (e.g., lipoma or haemorrhage) (13,18).…”

Abdominal wall endometriosis: accuracy of the diagnostic triad

“…The main differential considered with a soft tissue mass would be a desmoid tumor, haematoma, granuloma, ventral hernia, lipoma, sebaceous cyst, haemangiomas or lymphangioma. 15,16 In larger lesions the imaging report may assist with surgical planning especially when an abdominal wall reconstruction is anticipated. 17 Ultrasound shows an ill-defined hyperechoic lesion in the anterior abdominal wall at the site of the previous scar.…”

Beyond hernias: a multimodality review of abdominal wall pathology

“…metastases include melanoma, lung, renal and ovarian cancer. 8 Direct spread of a variety of intra-abdominal malignancies to the abdominal wall is also common.…”