Purpose or Case Report: Ultrasound is typically the first-line imaging modality for the evaluation of superficial soft tissue masses in the pediatric population. While certain superficial soft tissue masses have a classic appearance on ultrasound, others may have a nonspecific appearance and may vary in their sonographic characteristics. This can make a definitive diagnosis and follow-up recommendations difficult, especially for trainees.

We aim to provide a basic overview of some of the common and less common superficial soft tissue masses that may be encountered in pediatric imaging, and introduce a novel, structured algorithmic approach for evaluating these lesions on ultrasound. The algorithm will assist the radiologist in reaching a definitive diagnosis or narrowing the differential such that a helpful recommendation for further workup can be made. For example, the algorithm will include internal vascularity, border distinctness, cystic or solid components, presence or absence of calcifications, and location in the body and within the superficial soft tissue layers. Pictorial examples of each sonographic feature in the algorithm will provide further assistance.

Pathologies will include but not be limited to: pilomatricoma, glanuloma annulare, epidermal inclusion cyst, ganglion cyst, abscess/infection, lipoma, hematoma, lymph nodes, vascular anomalies, and soft tissue sarcomas. When a definitive diagnosis is not achievable, this algorithm will help the radiologist determine the likelihood of benignity, a short differential diagnosis, and a recommendation for any further imaging workup.
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