SA Medical - General Medicine And Imaging of Disease

An approach to soft tissue masses. Clinical examination and ultrasound review of soft tissue masses may lead to: A specific diagnosis A mass like lesion No sonographic abnormality Specific diagnosis include a foreign body, henia, ganglion cyst, lymph node, Bone and calcifications, epidermal cysts, abscess and hematoma. Mass like lesions may either be superficial and less than 5cm Characteristic of a lipoma ; consider clinical follow up or MRI Not characteristic of a lipoma; consider excision, needle biopsy, or MRI. Mass like lesions may be deep or greater than 5cm in depth.  Please consider an MRI of the extremity in question or a CT of the CHEST and ABDOMEN. In the event of a suspicious  clinical examination, but No sonographic abnormality ; consider MRI or CT. Specific diagnosis  on US:  a foreign body : including wood, glass and metal may be visualised on US. Wood usually has a echogenic focus with abnormal shadowing deep to the foreign body.

Baker cysts are most often found incidentally when the knee is imaged for other reasons. Baker cysts , or  popliteal cysts: Location: They are usually located at or below the joint line; arising in the popliteal fossa  between the medial head of the  gastrocnemius  and the  semimembranosus   tendons that communicates with the  knee joint .  T hey occur as a communication between the posterior joint capsule and the gastrocnemius-semimembranosus bursa,  resulting in fluid being squeezed in one direction . Consistency: fluid-filled distended synovial-lined lesions. They are not a true bursa nor a true cyst.  They are seen between 4-7 years and in adults above 35 years. Differential diagnosis:  DVT:  Symptomatic presentation may be acute when rupture occurs, in which case the chief differential diagnosis is  deep venous thrombosis .  Mass: A chronic/subacute presentation can manifest as a popliteal fossa mass or with pain. Ultrasound:  Normally the first line in