Soft Tissue Swellings Flashcards
A swelling causing what type of pain may suggest a malignancy?
A chronic, constant dull pain which keeps you up at night
What investigation is best to differentiate between fluid filled and solid nodules?
Ultrasound
What tests can be used to investigate soft tissue swelings?
Ultrasound, MRI, biopsy
What are lipomas and where do they usually occur?
Common benign fatty tumours which are usually seen in subcutaneous fat
How would you describe lipomas?
They are entirely benign. They are painless though can be large
Where in the upper limb are lipomas found?
At the back of the shoulder
Are liposarcomas common?
No, very rare
What is the commonest type of hand swelling?
Ganglion
Describe the outer and inner lining of a ganglion?
Fibrous outer lining and synovial inner lining
When ganglions occur at the DIP joint what do they become?
Mucous cysts
What are mucous cysts due to? Why should they be excised?
OA, there is a risk of infection
What is the success rate of aspiration of a ganglion? When should they be excised?
50% recurrence rate, should only be excised if painful
What is the second most common soft tissue swelling of the hand?
Giant cell tumour
Where do giant cell tumours usually occur on the hand?
The palmar surface, especially around the PIP of the index/middle fingers
Where do giant cell tumours arise from?
The synovium of a tendon sheath or joint
What do giant cell tumours contain?
Haemosiderin and multinucleate giant cells
How do giant cell tumours usually look?
They are usually well circumscribed but can be diffuse
Why should giant cell tumours be excised?
Because they are painful and can become malignant
What are some problems that giant cell tumours can cause?
Envelope a digital nerve or artery and can erode through bone
What is the risk of recurrence of giant cell tumours?
10-20%
What is pigmented villonodular synovitis?
A tumour from the synovium
What are the two types of pigmented villonodular synovitis?
Nodular or diffuse
Where is pigmented villonodular synovitis usually seen?
Large joints, especially the knee
What can pigmented villonodular synovitis result in?
Destruction and arthritis
What is the treatment for pigmented villonodular synovitis?
Synovectomy if young, joint replacement if old
What is a Baker’s cyst a type of?
Ganglion
A Baker’s cyst is a cyst from synovial fluid through a one way valve to where?
Semimembranosus bursa or medial gastrocnemius bursa
What is the outcome of a Baker’s cyst in children?
Will usually resolve
What does a Baker’s cyst in adults suggest?
Intra-articular pathology or arthritis
Should Baker’s cysts be excised? Why/why not?
No because there is a really high recurrence rate
What is bursitis?
Inflammation of a bursa
What is the function of a bursa?
Prevent friction
Where are the most common presentations of bursitis?
Olecranon, pre patellar, infra patellar, 1st metatarsal head (bunion)
What is the treatment for bursitis?
Arthroscopic bursectomy
What should you not do in cases of bursitis?
Inject or excise
What type of bursitis communicates with the knee joint? What is this usually a type of?
Suprapatellar bursa, usually septic arthritis
What types of bursitis are outwith the knee joint?
Infrapatellar and prepatellar
What is an implantation dermoid usually a result of?
Penetrating trauma
What happens in an implantation dermoid?
Epithelial cells in the subcutaneous tissue which form a reactive cyst with a pseudocapsule and grey fluid
Will a patient with an epidermoid cyst always recall an incident which caused it?
Not necessarily
Epidermoid (sebaceous) cysts are common and can occur everywhere except where?
Palms and soles
What happens in epidermoid cysts?
Epidermal cells get into the subcutaneous tissue and form a cyst, cells lining this cyst secrete keratin
How will an abscess present clinically?
Fluctuating in size and very painful
How is an abscess treated?
Excision and drainage
What is heterotrophic ossification/myositis ossificans?
Blunt trauma causes intramuscular haematoma which calcifies
How does heterotrophic ossification progress?
Usually painless, can diminish over time
What can heterotrophic ossification be confused with on MRI?
Osteosarcoma
What can heterotrophic ossification occur after? What does it cause?
Hip replacement- causes diminished range of movement
What are some treatment options for heterotrophic ossification?
Excision after 12 months or radiotherapy
How do malignant soft tissue swellings present?
Can occur at any age and are often painless
What is the first test for suspected soft tissue malignancy? If there is still uncertainty after this what should be done?
MRI, if unsure do biopsy
