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Found an interesting case. Anechoic a-vascular rounded non compressible lesions with posterior acoustic shadowing. They were seen within the subcutaneous plane of the left lateral upper arm. Assumptions of thrombosed varicose veins came up but there was no surrounding Superficial veins.
The patient was diagnosed with adenocarcinoma of the lunch. Some of the colleagues think it may be metastasis. -
Interesting appearance,
I don’t think it is a thromboses vein.
Being avascular is reassuring in terms of a metastatic deposit being unlikely.
Also it is in the subcutaneous fat layer so a metastasis is unlikely there with the exception of breast cancer local recurrence which can occur in the fat right under the skin.
So I think a metastasis is also unlikely.
What I think is most likely the diagnosis is an area of fat necrosis.
It has the perfect appearance for this diagnosis and being avascular also supports this diagnosis.
It is a common area for fat necrosis with the two leading causes being previous trauma or an injection.The upper arm is easily bumped and also is the most common site for injections of vaccines, which we have all had many of over the last few years.
So I am going for fat necrosis.
It is a similar process to what we call an oil cyst in a breast.
To be absolutely sure, given the patients history a FNA could be performed just to rule out anything sinister.
It is always best to be cautious.
Steve.
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Nice work Julius,
I see fat necrosis from injection sites around the upper arm, upper thigh and buttock areas.
Sometimes from legitimate vaccinations etc and sometimes from dodgy steroid use as these are easy areas to do self injected IM injections.
I also see it in trauma cases around the same areas and commonly in the female breast following trauma.
Great work Julius,
Let us know the FNA result.
Steve.
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