Purpose or Case Report: Superficial lesions are a frequent cause of concern in children. Ultrasound is usually the first imaging evaluation, but appearance is often nonspecific, can overlap, and may result in confusion and mischaracterization, possibly resulting in increased morbidity and mortality. Our purpose is to review important sonographic and other imaging features of various lesions and to emphasize the paramount importance of the natural history of particular lesions, in an effort to aid radiologists to narrow the differential diagnosis, direct management, prevent harm through the judicious use of advanced imaging and tissue sampling, and decrease the number of non-specific sonographic impressions in the radiology report.
Methods & Materials: We review the sonographic imaging characteristics, patient demographics, lesion natural history/clinical course, and differential diagnosis of several lesions which may help to distinguish various lesions, uncover masquerade lesions, and differentiate benign from malignant and aggressive from non-aggressive lesions. We include selected images for correlation across multiple modalities for lesions which have also undergone further evaluation with advanced imaging (e.g. CT or MRI).
Results: Representative lesions reviewed include malignant melanoma in a 3 year-old girl and leukemic chloroma in a 3 month-old infant, both masquerading as benign hemangiomas; posttraumatic nodular fasciitis of the forehead in a 3 year-old boy mimicking sarcoma; dermatofibrosarcoma protuberans in a 12 year-old female; vascular anomalies (e.g. hemangiomas/malformations); dermoids/epidermoids; lipomas; sinus pericranii; atretic cephalocele; and pilomatricoma, among others.
Conclusions: Malignant and other aggressive superficial lesions have overlapping sonographic findings and may mimic benign and non-aggressive entities and vice-versa. A familiarity with the sonographic appearance and natural history of these lesions can narrow the differential diagnosis, direct management, prevent harm through more judicious use of advanced imaging or biopsy, and decrease the number of nonspecific ultrasound reports.