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Musculoskeletal MBCHB > Soft Tissue Swellings > Flashcards

Soft Tissue Swellings Flashcards

1
Q

What is a lipoma?

A

neoplastic proliferation of fat

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2
Q

What is the aetiology of lipomas?

A

Usually occurs in the subcutaneous fat, can occur in muscle

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3
Q

What is the typical presentation of lipomas

A
  • Features suggestive of a benign soft tissue neoplasm include smaller size, fluctuation in size (malignant tumours don’t regress in size), cystic lesions, well‐defined lesions, fluid filled lesions and soft/fatty lesions
  • Lipomas have a characteristic consistency, with no overlying skin changes
  • Other features of lipomas: can be large (several cms), can be discreet or less well defined, slow growing and painless/ non-tender
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4
Q

What is the management of a lipoma?

A
  • Based on symptoms
  • Can be left alone
  • Surgical excision if causing symptoms
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5
Q

What is a giant cell tumour of the tendon sheath?

A

Benign nodular tumour found on the tendon sheath of the hands and feet

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6
Q

What is the pathophysiology of a giant cell tumour of the tendon sheath?

A
  • Benign regenerative hyperplasia with inflammatory process
  • Can be localised (common) or diffuse (uncommon, associated with pigmented villonodular synovitis)
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7
Q

What is the presentation of a giant cell tumour of the tendon sheath?

A
  • Firm, discreet swelling, usually on volar aspect of digits
  • Can occur in toes
  • May or may not be tender
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8
Q

What are the investigations for a giant cell tumour of the tendon sheath?

A

Imaging - x-ray, ultrasound, MRI

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9
Q

What does this image show?

A

Giant cell tumour of the tendon sheath

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10
Q

What is the management of a giant cell tumour of the tendon sheath?

A
  • Leave alone if no functional issue
  • Surgical excision - usually marginal excision (not complete) as tumour is adherent to tendon sheath
  • Incidence of recurrence
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11
Q

What is a mucous cyst?

A

Outpouching of synovial fluid from DIP caused by early OA

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12
Q

What is the aetiology of a mucous cyst?

A
  • Higher incidence in females
  • 40-60 years
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13
Q

What is the presentation of a mucous cyst?

A
  • Raised swelling of DIP/PIP joint or just distal to the joint (between joint crease and nail plate)
  • Painful
  • Always on the radial/ulnar side of the midline
  • Can fluctuate in size
  • Initially quite small but can increase in size and cause thinning of the skin
  • If the skin becomes very thin it can rupture and produce discharge
  • If it becomes particularly large it can deform the nail and cause a ridge
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14
Q

What is seen in this image?

A

Mucous Cyst

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15
Q

What is the management of a mucous cyst?

A
  • May be left alone - majority of cysts will completely disappear over time
  • In patients with particularly deep/cracked nail ridges, or those who are constantly discharging, consider excision
    • Often needs advancement/rotation flap if larger
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16
Q

What is a ganglion cyst?

A

Outpouchings of the synovium lining of joints and filled with synovial fluid

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17
Q

What is the aetiology of a ganglion cyst?

A

The weakness can be developmental (e.g. juvenile Baker’s cyst) or as a result of underlying joint damage/arthritis with build up of pressure within the joint (adult Baker’s cyst, mucous cyst of DIP joint, wrist ganglion)

18
Q

What is the pathophysiology of a ganglion cyst?

A
  • Not a true cyst as they have no epithelial lining
  • Histologically - space with myxoid material
19
Q

What is the presentation of a ganglion cyst?

A
  • Occur around a synovial joint or a synovial tendon sheath - commonly arise around the wrist, can also occur in feet and knees
  • Well-defined round swellings
  • <10mm - several cm
  • May be quite firm and readily transilluminate
  • They are usually painless/non-tender but may feel tight
  • Skin mobile, fixed to underlying structures
20
Q

What is seen in this image?

A

Ganglion cyst

21
Q

What is the management of a ganglion cyst?

A
  • Usually resolve with time but excision may be required for localized discomfort or cosmesis
  • Needle aspiration may be attempted but recurrence is common
  • The historic treatment of striking the wrist with a heavy book (‘bible technique’) to burst the swelling is not advised
22
Q

What is a sebaceous cyst?

A

Slow growing, painless, mobile discreet swellings formed by blockage of the sebaceous gland

23
Q

What is the aetiology of a sebaceous cyst?

A

Originate at hair follicles and fill with caseous material (keratin)

24
Q

What is the presentation of a sebaceous cyst?

A
  • Commonly occur on face, trunk and neck but can also occur on limbs
  • Can become infected
25
Q

What is seen in this image?

A

Sebaceous cyst

26
Q

What is the management of a sebaceous cyst?

A

May require excision and/or biopsy

27
Q

What is an abscess?

A

Discreet collection of pus

28
Q

What is the aetiology of an abscess?

A

Abscesses on a limb can occur from cellulitis, bursitis, penetrating wound or infected sebaceous cysts

29
Q

What is the presentation of an abscess?

A
  • Defined and fluctuant swelling
  • Erythema, pain
  • History of trauma (e.g. bite, IVDU) or cellulitis
30
Q

What is the management of an abscess?

A
  • Surgical excision and drainage
  • Rest, elevation, analgesia, splint
  • Antibiotics
31
Q

What is nodular fasciitis?

A

Benign proliferation of fibroblastic and myofibroblastic cells

32
Q

What is the histology of nodular fasciitis?

A

Very cellular, lots of mitoses figures, plump cells; stellate and spindle, tissue culture appearance, haemorrhage, mature towards periphery

33
Q

What is the presentation of nodular fasciitis?

A
  • Young adults, upper extremity
  • History of prior trauma at the site in 25% of cases
  • Rapidly growing
  • Superficial or deep
  • Usually <5cm
  • Usually circumscribed
34
Q

What is the management of nodular fasciitis?

A

None - reassurance, self-liming course

35
Q

What is myositis Ossificans?

A

Abnormal calcification of a muscle haematoma following trauma

36
Q

What is the presentation of myositis ossificans?

A
  • Initial soft swelling,
  • hardness develops over several weeks
37
Q

What is the investigations of choice for myositis ossificans?

A

X-ray and MRI - peripheral mineralisation

38
Q

What is the management of myositis ossificans?

A
  • Observation, intervene only if symptoms demand
  • Must wait until maturity of ossification (6-12 months), otherwise risk of recurrence
39
Q

What is bursitis?

A

Inflammation of the synovium-lined sacs that protect bony prominences and joints

40
Q

What is the aetiology of bursitis?

A
  • Can become inflamed after repeated pressure or trauma - may present as a soft tissue swelling
    • Pre‐patellar bursitis
    • Olecranon bursitis
    • Bunions (bursitis over the medial 1st metatarsal head in hallux valgus)
  • Can become secondarily infected and form an abscess (usually bacterial infection from a small wound on the limb)
41
Q

What is the management of bursitis?

A
  • With inflammatory bursitis the fluid component of the swelling usually subsides but a thickened bursal sac may be left
  • Recurrence may occur and excision may be required but problems can occur with scarring

Musculoskeletal MBCHB (21 decks)

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