The pitfalls of ultrasonography in the evaluation of soft tissue masses

Kwok, Henry; Pinto, Clinton; Doyle, Anthony

doi:10.1111/j.1754-9485.2012.02427.x

Cited by 11 publications

(9 citation statements)

References 10 publications

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“…Ultrasound is the primary examination method for superficial soft tissue masses to confirm their size, location and association between the masses and the surrounding structures. Through observations of the borders of the tissue masses, internal echo characteristics and internal blood flow signals, ultrasounds may provide a preliminary diagnosis that is inaccurate (4). Stiffness of the tissue structures may be accessed using ultrasound strain elastography (USE) (5), which is an effective tool for differentiating malignant and benign masses (6).…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of strain elastography for differentiating benign and malignant soft tissue masses

Liu

Lv³

2017

Oncology Letters

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The aim of the current study was to investigate the importance of strain elastography (SE) in the differential diagnosis of benign and malignant soft tissue masses. SE was adopted to examine 61 patients with superficial masses, classify their elastic scores and assess their strain ratios (SRs) between the masses and the surrounding structures. Significantly increased SR values and elastic scores were observed in the malignant masses compared with the benign masses (5.42±3.47 vs. 1.80±2.10, P<0.001; 3.13±0.34 vs. 2.03±0.99, P<0.001). Area under receiver operating characteristic curve values of the SRs and elastic scores were 0.87 (P<0.001) and 0.805 (P=0.001), respectively. With an SR of >2.295 as the optimal threshold value, the sensitivity, specificity and positive and negative predictive values for diagnosing a malignant mass were 93.8, 80.5, 65.2 and 97.1%, respectively; whilst using an elastic score of ≥3 as the optimal threshold value, the sensitivity, specificity and positive and negative predictive values for diagnosing a malignant mass were 100, 51.6, 51.6 and 100%, respectively. SR values and elastic scores were significantly different between the malignant and benign soft tissue masses. Therefore, SE may be used to effectively differentiate between malignant and benign soft tissue masses.

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Section: Introductionmentioning

confidence: 99%

Diagnostic value of strain elastography for differentiating benign and malignant soft tissue masses

Liu

Lv³

2017

Oncology Letters

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“…Prompt diagnostic evaluation by MRI and biopsy is essential to avoid delay in the management. Ultrasound examination has insufficient accuracy in the evaluation of soft tissue masses [ 10 ]. For example, misdiagnosis of soft tissue tumors by ultrasound examination conducted by radiologists is common, reaching up to 25%.…”

Section: Discussionmentioning

confidence: 99%

Ewing Sarcoma Misdiagnosed as a Traumatic Hematoma: A Case from Family Practice

Shammari

2021

Am J Case Rep

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Patient: Female, 13-year-old Final Diagnosis: Ewing sarcoma Symptoms: Swelling Medication:— Clinical Procedure: — Specialty: Family Medicine Objective: Mistake in diagnosis Background: Timely diagnosis of cancers is crucial, as delays can adversely affect a patient’s outcome and experience. Since soft tissue hematoma is a common clinical condition following trauma, soft tissue tumors can be misdiagnosed as hematomas due to the similar clinical features. Case Report: A 13-year-old girl presented with a gradually expanding swelling in the left arm that developed following minor trauma. She was seen by several general practitioners, and the swelling was managed as a soft tissue hematoma with the application of ice packs and compression, which did not result in any improvement. The initial plain radiograph of the left humerus revealed a large soft tissue swelling with areas of calcifications and minimal periosteal changes. The swelling was further evaluated by ultrasound, showing a hypoechoic lesion with internal septation and increased vascularity. These findings were mistakenly interpreted as a traumatic hematoma. Considering the prolonged duration and the progressive nature of the condition, the patient was referred for magnetic resonance imaging, which showed a soft tissue lesion involving the humeral shaft and sparing the proximal and distal epiphyses. An ultrasound-guided biopsy confirmed the diagnosis of Ewing sarcoma. Conclusions: Ewing sarcoma may present with a clinical picture similar to that of a traumatic hematoma. Hence, this case highlights the need for considering soft tissue tumors as a differential diagnosis in patients presenting with an expanding swelling. Primary care physicians should have a high index of suspicion for malignancies and should not be reluctant to refer patients for further investigations in cases exhibiting an unusual course of the clinical condition.

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“…One paper reported seven benign ultrasound cases that were malignant including four sarcomas originally reported as haematomas. [7] Another study reported 15 patients with an initial clinical or imaging diagnosis of a haematoma or haematoma versus hemorrhagic sarcoma. [5] In this paper, 13 sarcomas were in the thigh with 10 patients solely referred for a muscle strain/haematoma and another patient for a suspected haematoma versus abscess.…”

Section: Discussionmentioning

confidence: 99%

Soft-Tissue Sarcoma Masquerading as a Haematoma

Charnock

2019

Journal of Medical Ultrasound

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Sarcomas commonly occur in the buttock and thigh, although the clinical presentation varies with no specific symptoms other than a painless lump. This case study reports on a soft-tissue sarcoma that was initially thought to be a haematoma on ultrasound, despite being rescanned 6 weeks later. The patient presented back to their general practitioner 8 months later with the subsequent ultrasound showing an irregular and hypervascular soft-tissue mass. Further imaging and ultrasound-guided biopsy led to a surgical excision of a myxofibrosarcoma. This case demonstrates the difficulty of differentiating between a haematoma and sarcoma, especially in patients presenting with a history of trauma.

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The pitfalls of ultrasonography in the evaluation of soft tissue masses

Abstract: Ultrasonography lacks accuracy in the evaluation of soft tissue masses. Ongoing education is required to improve awareness of the limitations with its use. These limitations should be highlighted to the referrers, especially those who do not have specific training in this area.

Cited by 11 publications

References 10 publications

Diagnostic value of strain elastography for differentiating benign and malignant soft tissue masses

Diagnostic value of strain elastography for differentiating benign and malignant soft tissue masses

Ewing Sarcoma Misdiagnosed as a Traumatic Hematoma: A Case from Family Practice

Soft-Tissue Sarcoma Masquerading as a Haematoma

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