Article

Superficial soft tissue ultrasound

Soft tissue ultrasound: cysts, lipomas, collections and abscesses, foreign body, nodules and lymph nodes — technique, typical findings and normal report.

What it is and when to indicate it

Soft tissue ultrasound assesses palpable nodules and bulges, collections, suspected abscess, foreign body and superficial lymph nodes. It is fast, dynamic and guides management and drainage.

This page organizes the protocol in clear language and does not replace the original guidelines (AIUM, ACR, CBR), supervised training or clinical correlation.

Technique

• High-frequency linear transducer (7 to 18 MHz); use a gel standoff for very superficial lesions
• Examine the palpable point, measure in three dimensions and determine the layer (dermal, subcutaneous, muscular)
• Color Doppler for lesion vascularization and differentiation of collection vs solid
• Compare with the contralateral side when applicable
• Document in two planes with measurement

Typical lesions and how to recognize them

• Epidermal/sebaceous cyst: well-defined nodule, heterogeneous content, no internal flow
• Lipoma: oval mass, parallel to the skin, usually isoechoic/slightly hyperechoic, with striations
• Collection/abscess: anechoic/heterogeneous content, no internal flow, with peripheral hyperemia; test content mobility
• Foreign body: echogenic focus with shadowing and an inflammatory halo
• Indeterminate vascularized solid nodule: describe and refer when suspicious

Superficial lymph nodes

• Normal/reactive: oval shape, preserved central echogenic hilum, hilar vascularization
• Suspicious: rounded shape, loss of the hilum, eccentric cortical thickening, peripheral/chaotic flow
• Measure the short axis and describe the morphology
• Correlate with the clinical picture and the drainage territory
• Nonspecific lymphadenopathy is not synonymous with malignancy

Normal report template

• Skin and subcutaneous tissue of preserved thickness and echotexture at the examined point
• No nodules, collections or foreign body
• Underlying muscle planes without alterations
• Lymph nodes of usual appearance, when visible
• No inflammatory signs on Doppler

Limitations and pitfalls

• Excessive compression deforming small lesions: light support and a gel standoff
• Thick collection versus solid: use Doppler and compression to differentiate
• Lipoma versus other masses: value the morphology, but describe what stands out
• Radiolucent foreign body that only ultrasound shows
• Report limitations and suggest a complementary method/referral when indicated

Do not overdiagnose

Describe layer, dimensions, echotexture and vascularization, use recognizable patterns (cyst, lipoma, collection), and refer indeterminate or suspicious lesions without asserting histology. The conclusion should be proportional to the finding.

Sources

Educational content; it does not replace original guidelines, medical evaluation or supervised training. Main references:

• AIUM. Practice Parameter for the Performance of Ultrasound of Superficial Structures.
• ACR. Appropriateness Criteria and soft-tissue parameters (didactic support).
• Brazilian College of Radiology (CBR). Standardization and technical guidelines for ultrasound.
• Rumack CM, Levine D. Diagnostic Ultrasound (soft tissue).
• Radiopaedia. Soft tissue ultrasound (didactic support, not copied).

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