Intraosseous hemangioma is a rare, slow-growing, benign tumor of blood vessels. Primary hemangioma of the skull is a benign lesion that may appear as a palpable mass or accidentally detected during image evaluation. Simple radiography is the most commonly used technique to localize a lesion and computed tomography (CT) may help determine the effect of a lesion. We report a case of multifocal intraosseous calvarial hemangioma developed in the subgaleal plane of an elderly male patient. Ultrasonography examination revealed hyperechoic striated septae parallel to the skin and discontinuity of the focal cortex, however, the underlying bone cortex appeared relatively intact. No significant flow is observed on Doppler ultrasonography. Based on these evaluations, the mass was interpreted by a radiologist as a subgaleal lipoma. This case highlights the importance of additional CT examination in a patient presenting with a scalloping sign of the underlying calvarium. Clinicians also should be aware of the possibility of intraosseous calvarial hemangiomas in lesion. Furthermore, the proper choice of congenital vascular malformation term is still quite confusing with misconception present in the literature.
Aged ; Blood Vessels ; Hemangioma ; Humans ; Lipoma ; Male ; Pectinidae ; Radiography ; Skin ; Skull ; Ultrasonography ; Ultrasonography, Doppler ; Vascular Malformations

PURPOSE: The purpose of this study was to investigate the feasibility of shear wave ultrasound elastography for differentiating superficial benign soft tissue masses through a comparison of their shear moduli. METHODS: We retrospectively analyzed 48 masses from 46 patients from February 2014 to May 2016. Surgical excision, fine-needle aspiration, and clinical findings were used for the differential diagnosis. The ultrasonographic examinations were conducted by a single musculoskeletal radiologist, and the ultrasonographic findings were reviewed by two other radiologists who were blinded to the final diagnosis. Conventional ultrasonographic features and the median shear modulus were evaluated. We compared the median shear moduli of epidermoid cysts, ganglion cysts, and lipomatous tumors using the Kruskal-Wallis test. Additionally, the Mann-Whitney U test was used to compare two distinct groups. RESULTS: Significant differences were found in the median shear moduli of epidermoid cysts, ganglion cysts, and lipomatous tumors (23.7, 5.8, and 9.2 kPa, respectively; P=0.019). Epidermoid cysts showed a greater median shear modulus than ganglion cysts (P=0.014) and lipomatous tumors (P=0.049). CONCLUSION: Shear wave elastography may contribute to the differential diagnosis of superficial benign soft tissue masses through a direct quantitative analysis.
Biopsy, Fine-Needle ; Diagnosis ; Diagnosis, Differential ; Elastic Modulus ; Elasticity Imaging Techniques* ; Epidermal Cyst ; Ganglion Cysts ; Humans ; Lipoma ; Retrospective Studies ; Shear Strength ; Ultrasonography

Most esophageal lipomas are discovered incidentally and are small and asymptomatic. However, large (>4 cm) lipomas may cause various symptoms, including dysphagia, regurgitation, or epigastric discomfort. We present a 45-year-old woman with intermittent sudden choking and globus pharyngeus. Upper gastrointestinal endoscopy and endoscopic ultrasound revealed an approximately 10.0×1.5 cm pedunculated subepithelial tumor in the upper esophagus, identified as the cause of her symptoms. A thoracic computed tomography scan revealed a fat attenuated longitudinal mass along the upper esophagus, suggestive of a lipoma. Endoscopic resection of the lesion was performed with a detachable snare to relieve her symptoms, and the pathologic findings were consistent with a lipoma.
Airway Obstruction* ; Deglutition Disorders ; Endoscopy ; Endoscopy, Gastrointestinal ; Esophagus ; Female ; Humans ; Lipoma* ; Middle Aged ; SNARE Proteins ; Ultrasonography

BACKGROUND: Button osteoma presents as small circumscribed ivory-like lumps on the skull vault. Although not rare, its diagnosis can be challenging for dermatologists. OBJECTIVE: To clarify the clinical characteristics of button osteoma by reviewing 10 cases. METHODS: Ten patients diagnosed with button osteoma at the Department of Dermatology, Kyungpook National University Hospital, between January 2011 and August 2014 were enrolled. We retrospectively reviewed medical records and analyzed demographic and clinical characteristics including sex, age, sites, number of lesions, symptoms, duration, histopathological finding, radiological findings, and treatment. RESULTS: All patients presented with an asymptomatic small circumscribed hard lump fixed to a bony structure. There were 9 female and 1 male patient, and the mean age was 54 years (range, 28approximately61 years). The most common site was the forehead, and disease duration ranged from 2 weeks to more than 20 years. The differential diagnosis included cranial exostosis, ballooned osteoma, epidermal cyst, and lipoma. Simple radiography, ultrasonography, and computed tomography (CT) were used to make a confirmative diagnosis. Histopathological findings showed lamellated bony structures with poor vascularization. Ostectomy was performed for 5 patients, and no recurrence was detected within an average of 13.4 months after treatment. CONCLUSION: This review characterized button osteoma. Surgical excision is a useful therapeutic modality after CT-based diagnosis. Further studies with more patients are required to confirm the findings.
Dermatology ; Diagnosis ; Diagnosis, Differential ; Epidermal Cyst ; Exostoses ; Female ; Forehead ; Gyeongsangbuk-do ; Humans ; Lipoma ; Male ; Medical Records ; Osteoma* ; Radiography ; Recurrence ; Retrospective Studies ; Skull ; Ultrasonography

OBJECTIVE: To evaluate the value of enhancement features and quantitative parameters of contrast-enhanced ultrasonography (CEUS) in differentiating solid hypoechoic renal angiomyolipomas (AMLs) from clear cell renal cell carcinomas (ccRCCs). MATERIALS AND METHODS: We analyzed the enhancement features and quantitative parameters of CEUS in 174 hypoechoic renal masses (32 AMLs and 142 ccRCCs) included in the study. RESULTS: Centripetal enhancement pattern was more common in AMLs than in ccRCCs on CEUS (71.9% vs. 23.2%, p < 0.001). At peak enhancement, all AMLs showed homogeneous enhancement (100% in AML, 27.5% in ccRCCs; p < 0.001). Quantitative analysis showed no significant difference between rise time and time to peak. Tumor-to-cortex (TOC) enhancement ratio in AMLs was significantly lower than that in ccRCCs (p < 0.001). The criteria of centripetal enhancement and homogeneous peak enhancement together with TOC ratio < 91.0% used to differentiate hypoechoic AMLs from ccRCCs resulted in a sensitivity and specificity of 68.9% and 95.8%, respectively. CONCLUSION: Both qualitative and quantitative analysis with CEUS are valuable in the differential diagnosis of hypoechoic renal AMLs from ccRCCs.
Adult ; Aged ; Angiomyolipoma/*diagnosis/pathology/*ultrasonography ; Carcinoma, Renal Cell/*diagnosis/pathology/*ultrasonography ; Contrast Media ; Diagnosis, Differential ; Female ; Humans ; Kidney Neoplasms/diagnosis/pathology/*ultrasonography ; Language ; Lipoma/ultrasonography ; Male ; Middle Aged ; Sensitivity and Specificity

PURPOSE: Sacral cutaneous lesions in newborns are associated with numerous spinal abnormalities. Early detection is important, because spinal abnormalities may cause neurological symptoms. Radiologic screening tests have been performed on newborns with sacral cutaneous lesions. This study aimed to substantiate the associations between sacral cutaneous lesions and spinal abnormalities. METHODS: From January 2007 until November 2013, we retrospectively reviewed the charts of 743 newborns with sacral cutaneous lesions that included sacral dimples, which were deeper than 5 mm and situated further than 2.5 cm from the anus, deviated gluteal furrow, hairy patch, hemangioma, dyspigmentaion, and the presence of mass, and skin tag. RESULTS: 743 newborns with sacral cutaneous lesions were examined, including 24 newborns with abnormal ultrasonographic images. Tethered cord which affected 18 (2.4%) of the newborns, was the most commonly found spinal abnormaility. Of these 9 newborns had other spinal abnormalities in addition to tethered cord including lipoma, cyst, spina bifida occulta, lipomyelomeningocele, and dermal sinus tract, and 9 newborns had isolated tethered cord only. Other spinal abnormalities found included isolated lipoma (3 newborns, 0.4%), and subarachnoid cyst (2 newborns, 0.3%), and of the 2 newborns (0.3%) who had dermal sinus tract, 1 also had a lipoma and the other also had a tethered cord. Normal variants included coccygeal pit (43 newborns, 5.8%), and ventriculus terminalis (10 newborns, 1.4%). Of the 646 newborns with isolated sacral cutaneous lesion, 11 (1.7%) had abnormal ultrasonographic images, and of the 97 newborns with combined sacral cutaneous lesions, 13 (13.4%) had abnormal ultrasonograpic images. CONCLUSION: Sacral cutaneous lesions in newborns can be associated with spinal abnormalities, and the strongest marker of spinal abnormality is a combined lesion. Therefore, ultrasonography should be performed on newborns who present with sacral cutaneous lesions to detect and investigate any underlying spinal abnormalities.
Anal Canal ; Hemangioma ; Humans ; Infant, Newborn ; Lipoma ; Mass Screening ; Retrospective Studies ; Skin ; Spina Bifida Occulta ; Ultrasonography

BACKGROUND: Lipomas can be categorized into deep and superficial lipomas according to anatomical depth. Many cases of forehead lipomas are reported to be deep to the muscle layer. We analyze ultrasound in delineating depth of forehead lipomas. METHODS: A retrospective review was performed for all patients who underwent excision of forehead lipomas between January 2008 and March 2013 and for whom preoperative ultrasound study was available. Sensitivity and specificity of ultrasound imaging was evalauted against depth finding at the time of surgical excision. RESULTS: The review identified 42 patients who met the inclusion criteria. Preoperative ultrasound reading was 18 as deep lipomas and 24 as superficial. However, intraoperative finding revealed 2 of the 18 deep lipomas to be superficial and 13 of the 24 superficial lipomas to be deep lipomas. Overall, ultrasonography turned out to be 69% (29/42) accurate in correctly delineating superficial versus deep lipomas. CONCLUSION: Lipomas of the forehead tend to be located in deeper tissue plane compared to lipomas found elsewhere in the body. Preoperative ultrasonography of lipomas can be helpful, but was not accurate in identifying the depth of forehead lipomas in our patient population. Even if a forehead lipoma is found to be superficial on ultrasound, operative planning should include the possibility of deep lipomas.
Forehead* ; Humans ; Lipoma* ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography

Palpable inguinal mass in children should be differentiated from inguinal hernia, hydrocele, lymph node, and tumor. Though using ultrasonography, fatty tumor would be misdiagnosed as incarcerated inguinal hernia containing fatty component. We experienced the huge inguinal lipoblastoma in 5-year-old girl mimicking recurrent incarcerated hernia. Laparoscopic exploration revealed it was not incarcerated hernia but well demarcated bulging mass from abdominal wall. Mass was about 10x4x3 cm and extended from internal inguinal ring to saphenous opening. It was near total excised because of right external iliac vein injury. Pathologically, it was proven as lipoblastoma containing mature adipocyte with lipoblast and fibrous septa. Postoperatively, we noticed a segmental thrombotic occlusion of external iliac vein. After 1 year, she has no symptom related to occluded vessel. The remained lipoblastoma showed no interval change. Even lipoblastoma has a good prognosis with low recurrence rate, we need careful follow-up.
Abdominal Wall ; Adipocytes ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Hernia ; Hernia, Inguinal* ; Humans ; Iliac Vein ; Inguinal Canal ; Lipoblastoma* ; Lipoma ; Lymph Nodes ; Prognosis ; Recurrence ; Ultrasonography

Sparganosis is a kind of parasitic skin disease caused by sparganum, the plerocercoid larvae of the taper worm of the genus Spirometra. Sparganosis usually manifests as migrating or fixed subcutaneous nodules; therefore, it should be differentiated from lipoma, cysts, and cutaneous malignancies. Although the final diagnosis of sparganosis in humans depends on the identification of the worm in an infected tissue, suspicion for the presence of the parasite and careful history taking are important before making the diagnosis. However, it might be difficult for a clinician to suspect the existence of sparganosis because the incidence of this disease is extremely low. Therefore, an effective method for differentiating sparganosis from other skin disorders is needed. We suggest that ultrasonography could be an answer to this problem, on the basis of our experience of a case of cutaneous sparganosis in a 65-year-old woman showing very characteristic ultrasonographic findings.
Aged ; Diagnosis* ; Female ; Humans ; Incidence ; Lipoma ; Parasites ; Skin ; Skin Diseases, Parasitic ; Sparganosis* ; Sparganum ; Spirometra ; Ultrasonography*

The tarsal tunnel is located beneath the flexor retinaculum, which connects the medial malleolus and calacaneus. The tarsal tunnel contains the posterior tibialis tendon, flexor digitorum longus tendon, posterior tibial artery and vein, posterior tibial nerve, and flexor halluces longus tendon. Tarsal tunnel syndrome is a compressive neuropathy of posterior tibial nerve and its branches under the flexor retinaculum. The etiologies of tarsal tunnel syndrome are space-occupying lesion, hypertrophied flexor retinaculum, osteophytes, tarsal coalition, varicose vein, and trauma. The symptoms are foot pain and hypoesthesia or paresthesia at dermatome according to involving nerve branches. Clinical diagnosis can be obtained from a detailed history and physical examination such as compressive test at the tarsal tunnel area. Ultrasonography and magnetic resonance imaging can reveal the space-occupying lesion, such as ganglion, lipoma, and neuroma. The initial treatments of tarsal tunnel syndrome are conservative management, such as physical therapy, night splint, and steroid injection. Surgical decompression is indicated after failure of conservative managements. Variable results of surgical treatment have been reported. Favorable result after decompression could be obtained from young patients, early onset symptoms, and space-occupying lesion.
Decompression ; Decompression, Surgical ; Diagnosis ; Foot ; Ganglion Cysts ; Humans ; Hypesthesia ; Lipoma ; Magnetic Resonance Imaging ; Neuroma ; Osteophyte ; Paresthesia ; Physical Examination ; Splints ; Tarsal Tunnel Syndrome* ; Tendons ; Tibial Arteries ; Tibial Nerve ; Ultrasonography ; Varicose Veins ; Veins