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Superficial soft tissues

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Abstract

Ultrasonography of the superficial soft tissues is indicated in order to: further examine cutaneous and subcutaneous nodules or masses; differentiate nodules and masses from lymph nodes; examine the body wall; search for foreign bodies; examine the mammary glands; and assess the body wall for defects (congenital or acquired). This chapter considers the value of ultrasonography compared with radiography. Imaging technique and normal ultrasonographic appearance are explained before the chapter focuses on mammary glands, superficial swellings and masses, and brachial plexus. This chapter contains 11 video clips.

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Figures

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21.1 Ultrasonogram of the normal superficial soft tissues at the level of the caudal abdominal ventral wall. The normal skin (SK), hypoechoic subcutaneous tissue (S) and abdominal wall musculature (M) are visible.
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21.2 Lactating mammary gland. The mammary gland tissue (MG) extends between the skin (S) and the abdominal wall musculature (M). It has a medium echogenicity with a coarse granular echotexture. Colour Doppler ultrasonograms showing the abundant vasculature, and one round small structure without flow signal representing a dilated milk duct (arrowheads).
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21.3 Mammary gland cysts. These cysts appear as round anechoic structures. There is no evidence of blood flow on colour Doppler ultrasonography.
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21.4 Ultrasonographic findings of mammary gland neoplasia can be variable. Small hypoechoic nodule with irregular margins. Diagnosis was confirmed as a mixed benign tumour. Well marginated homogeneous nodule with some edge shadowing. Diagnosis was confirmed as an adenocarcinoma. Irregular, heterogeneous mass with low vascularization. Diagnosis was confirmed as an inflammatory carcinoma.
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21.5 Typical ultrasonographic appearance of a subcutaneous abscess. The abscess was located in the cervical region. The lesion is well marginated and has a thick, slightly irregular hyperechoic wall and scattered echogenic content.
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21.6 Subcutaneous foreign bodies. Plant awn located under the 10th rib. The foreign body is visible as a linear spindle-shaped hyperechoic structure with multiple parallel reflecting interfaces, surrounded by a hypoechoic halo representing oedematous tissue. The hyperechoic interface on the left of the image corresponds to the pleural surface of the left caudal lung lobe (arrowheads). Porcupine spine located in the deep part of the temporal muscle. The dog was presented with a fistula in the skin in the zygomatic region. The foreign body (FB) appears as a hyperechoic pointed structure with sharp margins. The tip of the foreign body (on the right) is in contact with the hyperechoic bone surface of the coronoid process of the mandible (arrowheads). The temporal muscle (TM) is heterogeneous due to the inflammatory process.
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21.7 Lateral abdominal wall of a dog following a bite injury. The subcutaneous tissue is thickened and heterogeneous. Note that there are small bowel loops visible just under the skin (arrowed). The muscular wall is interrupted. The two vertical white lines indicate the ends of the ruptured muscular wall. Through the gap, a small bowel loop is visible extending toward the subcutis (arrowheads).
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21.8 Large subcutaneous mass of the humeral region, histologically diagnosed as a peripheral nerve sheath tumour. The mass is very heterogeneous with irregular hypoechoic and anechoic zones. Many of these hypoechoic and anechoic zones represent vessels, as demonstrated on colour Doppler.
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21.9 Typical ultrasonographic appearance of a lipoma. The mass is well marginated with smooth margins, homogeneous and mostly isoechoic with the surrounding tissue. Note also the striated pattern produced by thin parallel hyperechoic lines.
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21.11 Ultrasonograms of the lateral aspect of the neck, thoracic inlet and axillary region. The ventral branches of the sixth, seventh and eighth cervical spinal nerves contributing to the brachial plexus, and the major nerve components of the plexus can be identified with ultrasonography. Transverse view of the sixth spinal nerve at the level of the intervertebral foramina. The nerve appears as a hypoechoic round structure of 1–2 mm diameter surrounded by a hyperechoic rim (circle). The hyperechoic interfaces produced by the transverse processes of the fifth and sixth vertebrae (arrowheads) are also visible. Rotation of the probe through 90 degrees in a mild ventrocaudal direction enables the nerve to be seen in a longitudinal view. The nerve is seen as an elongated hypoechoic band (arrowheads). In a more distal position, the nerve appears to be formed by multiple adjacent branches (circle). Brachial plexus as seen from a thoracic inlet window. The probe is aligned longitudinally between the sternum and the scapula. Multiple round, hypoechoic, nerve roots are visible. The axillary vein and artery are located close to the nerves but are not visible in this image. Brachial plexus as seen from an axillary window. Multiple small nerve roots (arrowed) are located close to the axillary artery (a) and vein (v).
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21.12 Nerve sheath tumour of the brachial plexus. The tumour increases the size of the nerve root, producing a homogeneous, hypoechoic, tubular mass, which follows the path of the nerve.

Supplements

Lactating mammary gland.

The mammary gland tissue extends between the skin and the abdominal wall musculature. It has a medium echogenicity with a coarse granular echotexture. Colour Doppler examination shows the abundant supplying vasculature.

Mammary cysts.

This clip shows multiple well defined, rounded, anechoic structures within the mammary gland. No blood flow was evident on Doppler examination. These findings are characteristic of mammary cysts.

Abscess.

This abscess was located in the soft tissues of the neck and shows a typical ultrasonographic appearance. The lesion is well marginated with a thick, irregular hyperechoic wall. It contains fluid with swirling echoes, indicating cells and/or debris.

Foreign body (1).

In this patient, a plant awn was located under the 10th rib. The foreign body is visible as a spindle-shaped hyperechoic structure with multiple parallel reflecting interfaces, surrounded by a hypoechoic halo representing oedematous tissue. The hyperechoic interface on the left of the screen corresponds to the pleural surface of the left caudal lung lobe (arrowheads). The lung gently moves during respiration. Comet tail artefacts are visible at the lung surface.

Foreign body (2).

This dog was presented with a fistula in the zygomatic region. A porcupine spine was located in the deep part of the temporal muscle. The foreign body appears as a hyperechoic pointed structure with sharp margins. The tip of the foreign body (on the right of the screen) is in contact with the hyperechoic bone surface of the coronoid process of the mandible. The temporal muscle is inhomogeneous due to the inflammatory process.

Abdominal wall injury (1).

This clip shows an examination of the lateral abdominal wall of a dog after a bite injury. The subcutaneous tissue is thickened and heterogeneous, with small intestinal loops visible just under the skin.

Abdominal wall injury (2).

The same dog as in Abdominal wall injury (1). The muscular wall is interrupted. Through the gap, a small bowel loop is visible extending toward the subcutis.

Soft tissue neoplasm (1).

This dog had a large subcutaneous mass in the humeral region, histologically diagnosed as schwannoma. The mass is very heterogeneous with irregular hypoechoic and anechoic foci.

Soft tissue neoplasm (2).

The same dog as in Soft tissue neoplasm (1). Colour Doppler shows flow within many of the foci, confirming the highly vascular nature of this neoplasm.

Lipoma.

This short clip shows the typical ultrasonographic appearance of a lipoma. The mass is well marginated, homogeneous and mostly isoechoic with the surrounding tissue, with a striated pattern produced by thin parallel hyperechoic lines.

Nerve sheath tumour in the brachial plexus.

The tumour increases the size of the nerve root, producing a homogeneous, hypoechoic, tubular mass that follows the path of the nerve.

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