Diagnostic ultrasound ( PDFDrive )

1666 PART V Pediatric Sonography
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B
FIG. 48.63 Rhabdomyosarcoma. Five-month-old with hard mass in the left cheek. (A) Color Doppler ultrasound image shows a hypoechoic,
hypovascular, irregular, poorly marginated mass in the left cheek. (B) T1-weighted postcontrast magnetic resonance image shows a heterogeneously
enhancing mass in the left cheek (arrow). The mass had increased in size compared with the ultrasound performed 3 weeks beforehand.
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FIG. 48.64 Neuroblastoma. Three-year-old with left cheek swelling. (A) Ultrasound image shows a hypoechoic mass in the deep soft tissues
of the left cheek inseparable from the left mandibular ramus, which is poorly deined and contains radiating echogenic bands consistent with
aggressive periostitis. (B) Computed tomography image through the mandible shows expansion of the left hemimandible with aggressive periosteal
reaction and soft tissue mass.
bony lesions may also manifest as facial or calvarial bumps referred
for sonographic evaluation. Orbital metastasis of neuroblastoma
is most frequent, but other facial bones such as the maxilla and
mandible can be involved as well. 214 It is important to recognize
underlying osseous involvement, which can be seen as radiating
echogenic bands relecting the aggressive periosteal reaction 214
(Fig. 48.64).
Other Neoplasms. An unusual sot tissue mass in the head
and neck should raise concern for malignancy in children.
Leukemic sot tissue deposits or granulocytic sarcomas (previously
called “chloromas”) should be considered (Fig. 48.65) in children
with leukemia. Less common malignancies include other rare
sot tissue sarcomas such as infantile ibrosarcoma, osteosarcoma,
or Ewing sarcoma. he presentation and sonographic appearances
may be nonspeciic, and additional imaging with biopsy is frequently
needed for diagnosis.
Metastatic Disease. Metastatic nodal disease is uncommon
in pediatrics. 144 Neuroblastoma, rhabdomyosarcoma, and thyroid
cancer are the most likely causes. Imaging usually cannot differentiate
reactive, inlammatory, or neoplastic disease. 144,208
Clinical concerns for neoplasm include onset in neonatal period,
rapid growth, skin ulceration, ixation to skin, and large, hard
masses. 191 With ultrasound, suspicious indings have been deined.
Tumor invasion typically starts in the cortex, so changes in the