Soft tissue swellings Flashcards
What pain is associated with malignancy
Knawing night pain
How to take a history of a swelling
duration pain change in size -growing -fluctuation history of injury solitary or multiple
Examination of a swelling
site size definiton-well or ill defined consistency- smooth or irregular Mobile or fixed- to skin or deep tissues temperature-abscess transilluminablesolid or cystic pulsatility overlying skin changes lymphadenopathy
Benign
small size fluctuation in size cystic/fluid filled well defined soft/fatty
Worrying features
>5cm rapid growing solid ill defined regular surface systemic upset lymphadenopathy
USS tells us
cystic or non cystic
MRI tells us
Better anatomical definition
-tissue type
-relationship to nerve and vessels
good at diagnosing benign lesions
poorer histologic correlation with more aggressive lesions
can identify aggressive/worrying features
-biopsy
Worrying features on MRI
>5cm deep location heterogenicity/necrosis bone or neuromuscular involvemnt ganglinium enhancement -malignant tend to enhance more enlarged lymph nodes
What is lypoma
fatty benign tumour ( tend to be in shoulders and arms)
soft - tethered to skin but not deep strutures
painless and gradually enlarge
usually in submit fat, can occur in muscle
ganglion
commonest hand swellling
associated with underlying OA
fibrous outer lining and synovial inner lining
wrist, DIDJ,foot, ankle, knee
should transilluminate
DIPJ-mucous cyst (also fuse joints if you chop them out)
50% recurrence
Bakers cyst
out-touching of synovial membrane through the back of the knee
do not operate
Bursitis common presentations
olecranon, pre patellar, infra patellar and 1st metatarsal head 9 bunion)
What happens if you put a needle in a bursae
sinus ( which will go on for months and need to be drained )
DO NOT INJECT A BURSITIS
What is a implantation dermatoid
penetrating trauma- epithelial cells into submit tissue
not cancerous
What is epidermoid ( sebaceous) cyst
common
can occur anywhere except palms and soles
epidermal cells find their way into submit tissues
epidermoid cells lingo cyst secrete keratin
often have punctum
Abcess may arise from…
cellulitis, infected wound, epidermoid cyst, blocked sweat gland, injection site etc
Why does access need Incision and drainage rather than antibiotics
a walled area of avascular tissue therefore antibiotics will not work as it can’t get to it
What is heterotrophic ossification
ossification in the wrong place often from blunt trauma
usually painless and diminish over time
will be in musculature, difficult to feel borders, not pulsatile
( can be confused with osteosarcoma on MRI)
What is rhabdomyosarcoma
malignancy of skeletal muscle
Angiosarcoma is a malignancy of
blood vessel
What is synovial sarcoma a malignancy of
synovial joint or tendon sheath
If the nature of a lesion is indeterminate after clinical assessment and MRI then what must be performed
biOPSY
