DOI: 10.1148/rg.265055729
Superficial Soft-Tissue Masses of the Extremities1
Marcia F. Blacksin, MD,
Doo-Hoe Ha, MD,
Meera Hameed, MD and
Seena Aisner, MD
1 From the Departments of Radiology (M.F.B.) and Pathology (M.H., S.A.), New Jersey Medical School, University of Medicine and Dentistry, University Hospital, C-320, 150 Bergen St, Newark, NJ 07103-2426; and Department of Radiology, College of Medicine, Ponchon CHA University, Bundang CHA General Hospital, Sungnam-si, Kyonggi-do, South Korea (D.H.H.). Received November 4, 2005; revision requested January 13 and received February 28, 2006; accepted March 7. All authors have no financial relationships to disclose.
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Figure 1. Schema shows the layers and specialized structures of the skin.
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Figure 2. Type 1 neurofibromatosis in a 16-year-old girl. Axial T2-weighted fat-suppressed MR image of the thigh shows a subcutaneous neurofibroma (arrowhead) with a low-signal-intensity central target sign and the excision site (arrow) of a previous neurofibrosarcoma.
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Figure 3a. Hemangiomatosis and lymphangiomatosis in a child. (a) Coronal T1-weighted MR image shows reticulation in the subcutaneous fat of the upper part of the left leg (arrowheads). (b) Axial inversion recovery MR image shows a large central vessel (arrow) and a branching pattern of reticulation (arrowhead).
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Figure 3b. Hemangiomatosis and lymphangiomatosis in a child. (a) Coronal T1-weighted MR image shows reticulation in the subcutaneous fat of the upper part of the left leg (arrowheads). (b) Axial inversion recovery MR image shows a large central vessel (arrow) and a branching pattern of reticulation (arrowhead).
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Figure 4a. Granuloma annulare in a 9-year-old girl. (a) Lateral radiograph of the tibia shows a superficial soft-tissue mass in the pretibial region (arrowhead). (b) Axial CT image shows a soft-tissue lesion (arrow) with an irregular superficial margin and lower attenuation than that in muscle.
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Figure 4b. Granuloma annulare in a 9-year-old girl. (a) Lateral radiograph of the tibia shows a superficial soft-tissue mass in the pretibial region (arrowhead). (b) Axial CT image shows a soft-tissue lesion (arrow) with an irregular superficial margin and lower attenuation than that in muscle.
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Figure 5a. Leukemia cutis in a 29-year-old man with acute T-cell lymphoblastic leukemia. (a) Photograph shows a purple macular rash on the man’s face and shoulders. (b) Sagittal T2-weighted image shows ulceration (arrowhead) in an intermediate-signal-intensity dermal and epidermal mass (arrow) on the dorsum of the foot.
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Figure 5b. Leukemia cutis in a 29-year-old man with acute T-cell lymphoblastic leukemia. (a) Photograph shows a purple macular rash on the man’s face and shoulders. (b) Sagittal T2-weighted image shows ulceration (arrowhead) in an intermediate-signal-intensity dermal and epidermal mass (arrow) on the dorsum of the foot.
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Figure 6a. Primary melanoma on the plantar surface of the foot. (a) Short-axis axial T1-weighted MR image shows a low-signal-intensity neoplasm in the deep dermis and epidermis (arrow). The signal in the lesion is isointense or slightly hyperintense compared with that in muscle. (b) Short-axis axial T2-weighted MR image shows a mild, inhomogeneous increase in signal intensity in the lesion (arrow).
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Figure 6b. Primary melanoma on the plantar surface of the foot. (a) Short-axis axial T1-weighted MR image shows a low-signal-intensity neoplasm in the deep dermis and epidermis (arrow). The signal in the lesion is isointense or slightly hyperintense compared with that in muscle. (b) Short-axis axial T2-weighted MR image shows a mild, inhomogeneous increase in signal intensity in the lesion (arrow).
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Figure 7. Ancient schwannoma in a 42-year-old woman. Axial T2-weighted fat-suppressed MR image shows a well-defined high-signal-intensity lesion (arrowhead) that contains a discrete central focus of necrosis with an ill-defined low-signal-intensity margin (arrow).
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Figure 8a. Cutaneous angioleiomyoma adjacent to the patella in a 26-year-old man. (a) Axial T1-weighted MR image shows a well-defined, homogeneous, oval lesion (arrowhead) that appears to have invaded the capsule. The results of a histologic analysis showed no capsular infiltration. (b) Axial T2-weighted fat-suppressed MR image shows heterogeneous high signal intensity in the lesion (arrowhead).
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Figure 8b. Cutaneous angioleiomyoma adjacent to the patella in a 26-year-old man. (a) Axial T1-weighted MR image shows a well-defined, homogeneous, oval lesion (arrowhead) that appears to have invaded the capsule. The results of a histologic analysis showed no capsular infiltration. (b) Axial T2-weighted fat-suppressed MR image shows heterogeneous high signal intensity in the lesion (arrowhead).
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Figure 9a. Giant cell tumor of the soft parts adjacent to the knee in a 71-year-old woman. (a) Sagittal T1-weighted MR image shows a round inhomogeneous lesion (arrow) in the subcutaneous fat. The lesion has higher signal intensity than that in muscle. (b) Axial T2-weighted fat-suppressed MR image shows mildly increased signal intensity in most of the lesion (arrow) and a low-signal-intensity focus that may reflect hemosiderin deposition.
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Figure 9b. Giant cell tumor of the soft parts adjacent to the knee in a 71-year-old woman. (a) Sagittal T1-weighted MR image shows a round inhomogeneous lesion (arrow) in the subcutaneous fat. The lesion has higher signal intensity than that in muscle. (b) Axial T2-weighted fat-suppressed MR image shows mildly increased signal intensity in most of the lesion (arrow) and a low-signal-intensity focus that may reflect hemosiderin deposition.
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Figure 10. Dermatofibrosarcoma protuberans of the foot in a 33-year-old woman. Short-axis axial contrast-enhanced T1-weighted fat-suppressed MR image shows a lesion with marked inhomogeneous enhancement (arrow). The results of a histologic analysis demonstrated the penetration of the lesion through the dermis and subcutaneous fat layer to the fascia.
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Figure 11a. Epithelioid sarcoma in the finger of a 52-year-old man. (a) Sagittal T1-weighted MR image shows a heterogeneous low-signal-intensity neoplasm on the dorsal surface of the finger at the level of the middle phalanx (arrow). (b) Axial T2-weighted fat-suppressed MR image of the ipsilateral elbow shows an enlarged lymph node with inhomogeneous signal intensity (arrowheads).
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Figure 11b. Epithelioid sarcoma in the finger of a 52-year-old man. (a) Sagittal T1-weighted MR image shows a heterogeneous low-signal-intensity neoplasm on the dorsal surface of the finger at the level of the middle phalanx (arrow). (b) Axial T2-weighted fat-suppressed MR image of the ipsilateral elbow shows an enlarged lymph node with inhomogeneous signal intensity (arrowheads).
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Figure 12a. Sweat gland carcinoma in the hand of a 40-year-old man. (a) Coronal T1-weighted MR image shows an inhomogeneous mass (arrow) adjacent to the first metacarpal bone. (b) Axial contrast-enhanced T1-weighted fat-suppressed image shows the inhomogeneous enhancement and ill-defined edges of the mass (arrow).
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Figure 12b. Sweat gland carcinoma in the hand of a 40-year-old man. (a) Coronal T1-weighted MR image shows an inhomogeneous mass (arrow) adjacent to the first metacarpal bone. (b) Axial contrast-enhanced T1-weighted fat-suppressed image shows the inhomogeneous enhancement and ill-defined edges of the mass (arrow).
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Figure 13. Merkel cell carcinoma in the upper arm of a 64-year-old woman. Sagittal T1-weighted MR image shows an ill-defined lesion (arrow) located in the subcutaneous fat and extending to the dermis. The lesion has signal isointense to that in muscle and hypointense to that in adjacent fat. The subcutaneous fat stranding is indicative of inflammation.
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Figure 14a. Lipoma in the subcutaneous fat layer in the shoulder of a 30-year-old man. Axial T1-weighted MR image (a) and axial T2-weighted fat-suppressed MR image (b) show a discrete soft-tissue mass with internal signal intensity identical to that of fat (arrowhead) and, in a, a surrounding thin rim of low signal intensity that represents a capsule.
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Figure 14b. Lipoma in the subcutaneous fat layer in the shoulder of a 30-year-old man. Axial T1-weighted MR image (a) and axial T2-weighted fat-suppressed MR image (b) show a discrete soft-tissue mass with internal signal intensity identical to that of fat (arrowhead) and, in a, a surrounding thin rim of low signal intensity that represents a capsule.
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Figure 15. Granular cell tumor in a 24-year-old woman. Coronal T2-weighted MR image shows an oval lesion with low signal intensity (arrow) in the subcutaneous fat of the foot, near the heel.
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Figure 16. Subcutaneous nodular fasciitis in a 33-year-old-man. Axial T2-weighted inversion recovery MR image shows a lesion (arrowhead) with a lobular contour, a thin surrounding capsule, and a low-signal-intensity core in the subcutaneous fat layer adjacent to the fascia.
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Figure 17a. Superficial malignant fibrous histiocytoma in a 44-year-old man. (a) Coronal T1-weighted MR image shows a multilobulated low-signal-intensity lesion in the subcutaneous fat (arrowhead) adjacent to the iliotibial band, with edema (arrow) in the surrounding soft tissue. (b) Axial T2-weighted fat-suppressed MR image shows inhomogeneous high signal intensity in the tumor (arrowhead) and the surrounding region of soft-tissue edema (arrow).
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Figure 17b. Superficial malignant fibrous histiocytoma in a 44-year-old man. (a) Coronal T1-weighted MR image shows a multilobulated low-signal-intensity lesion in the subcutaneous fat (arrowhead) adjacent to the iliotibial band, with edema (arrow) in the surrounding soft tissue. (b) Axial T2-weighted fat-suppressed MR image shows inhomogeneous high signal intensity in the tumor (arrowhead) and the surrounding region of soft-tissue edema (arrow).
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Figure 18. Synovial sarcoma. Sagittal T2-weighted fat-suppressed MR image shows a well-defined homogeneous high-signal-intensity lesion (arrowhead) with internal septa. The lesion is located on the superficial surface of the Achilles tendon.
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Figure 19a. Rheumatoid arthritis. (a) Short-axis axial T1-weighted MR image of the foot shows low-signal-intensity rheumatoid nodules (arrows) under the metatarsal heads. (b) Short-axis axial T2-weighted inversion recovery image shows low signal intensity in most of the nodules (arrow), with peripheral areas of high signal intensity in the lateral lesions (conjoined arrows). Adventitial bursitis adjacent to the lateral nodules (arrowhead) also is visible.
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Figure 19b. Rheumatoid arthritis. (a) Short-axis axial T1-weighted MR image of the foot shows low-signal-intensity rheumatoid nodules (arrows) under the metatarsal heads. (b) Short-axis axial T2-weighted inversion recovery image shows low signal intensity in most of the nodules (arrow), with peripheral areas of high signal intensity in the lateral lesions (conjoined arrows). Adventitial bursitis adjacent to the lateral nodules (arrowhead) also is visible.
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Figure 20a. Gout. (a) Axial CT image of the hand of a 44-year-old woman shows calcification in tophi (white arrows) and a well-defined area of erosion (black arrow) in a phalanx. (b) Axial T1-weighted MR image of the ankle of a 56-year-old man shows an intermediate-signal-intensity tophus adjacent to the lateral aspect of the fibula (arrow). (c) Axial T2-weighted MR image of the ankle shows a tophus (arrow) with both high-and low-signal-intensity components.
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Figure 20b. Gout. (a) Axial CT image of the hand of a 44-year-old woman shows calcification in tophi (white arrows) and a well-defined area of erosion (black arrow) in a phalanx. (b) Axial T1-weighted MR image of the ankle of a 56-year-old man shows an intermediate-signal-intensity tophus adjacent to the lateral aspect of the fibula (arrow). (c) Axial T2-weighted MR image of the ankle shows a tophus (arrow) with both high-and low-signal-intensity components.
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Figure 20c. Gout. (a) Axial CT image of the hand of a 44-year-old woman shows calcification in tophi (white arrows) and a well-defined area of erosion (black arrow) in a phalanx. (b) Axial T1-weighted MR image of the ankle of a 56-year-old man shows an intermediate-signal-intensity tophus adjacent to the lateral aspect of the fibula (arrow). (c) Axial T2-weighted MR image of the ankle shows a tophus (arrow) with both high-and low-signal-intensity components.
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Figure 21a. Kimura disease. (a) Axial T1-weighted image shows an inhomogeneous subcutaneous lesion in the thigh, with signal intensity higher than that of muscle (arrowhead). Fat stranding is visible at the lesion margin. (b) Axial T2-weighted image shows a peripheral region of high signal intensity and a central region of low signal intensity in the lesion (arrowhead). (c) Sagittal contrast-enhanced T1-weighted fat-suppressed image shows an ill-defined enhanced mass in the groin (arrowhead).
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Figure 21b. Kimura disease. (a) Axial T1-weighted image shows an inhomogeneous subcutaneous lesion in the thigh, with signal intensity higher than that of muscle (arrowhead). Fat stranding is visible at the lesion margin. (b) Axial T2-weighted image shows a peripheral region of high signal intensity and a central region of low signal intensity in the lesion (arrowhead). (c) Sagittal contrast-enhanced T1-weighted fat-suppressed image shows an ill-defined enhanced mass in the groin (arrowhead).
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Figure 21c. Kimura disease. (a) Axial T1-weighted image shows an inhomogeneous subcutaneous lesion in the thigh, with signal intensity higher than that of muscle (arrowhead). Fat stranding is visible at the lesion margin. (b) Axial T2-weighted image shows a peripheral region of high signal intensity and a central region of low signal intensity in the lesion (arrowhead). (c) Sagittal contrast-enhanced T1-weighted fat-suppressed image shows an ill-defined enhanced mass in the groin (arrowhead).
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Figure 22a. Morel-Lavallée lesion in a 52-year-old woman after a motor vehicle accident. (a) Coronal T1-weighted MR image shows a fusiform homogeneous low-signal-intensity lesion in the subcutaneous fat layer (arrowhead) adjacent to the fascia. Fat stranding (arrow) also is visible. (b) Axial T2-weighted fat-suppressed image shows a fluid collection with a well-defined superficial margin and internal debris (arrowhead), as well as fat stranding (arrow).
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Figure 22b. Morel-Lavallée lesion in a 52-year-old woman after a motor vehicle accident. (a) Coronal T1-weighted MR image shows a fusiform homogeneous low-signal-intensity lesion in the subcutaneous fat layer (arrowhead) adjacent to the fascia. Fat stranding (arrow) also is visible. (b) Axial T2-weighted fat-suppressed image shows a fluid collection with a well-defined superficial margin and internal debris (arrowhead), as well as fat stranding (arrow).
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Copyright © 2006 by the Radiological Society of North America.
