Pucciarelli Francesco, Faugno Maria Carla, Valanzuolo Daniela, Massaro Edoardo, De Sanctis Lorenzo Maria, Zaccaria Elisa, Zerunian Marta, De Santis Domenico, Polici Michela, Polidori Tiziano, Laghi Andrea, Caruso Damiano
Radiology Unit, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, 00189 Rome, Italy.
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy.
J Imaging. 2025 Jun 30;11(7):217. doi: 10.3390/jimaging11070217.
Soft tissue masses are predominantly benign, with a benign-to-malignant ratio exceeding 100:1, often located around joints. They may be contiguous or adjacent to joints or reflect systemic diseases or distant organ involvement. Clinically, they typically present as palpable swellings. Evaluation should consider duration, size, depth, and mobility. Also assess consistency, growth rate, symptoms, and history of trauma, infection, or malignancy. Laboratory tests are generally of limited diagnostic value. The primary clinical goal is to avoid unnecessary investigations or procedures for benign lesions while ensuring timely diagnosis and treatment of malignant ones. Imaging plays a central role: it confirms the presence of the lesion, assesses its location, size, and composition, differentiates between cystic and solid or benign and malignant features, and can sometimes provide a definitive diagnosis. Imaging is also crucial for biopsy planning, treatment strategy, identification of involved structures, and follow-up. Ultrasound (US) is the first-line imaging modality for palpable soft tissue masses due to its low cost, wide availability, and lack of ionizing radiation. If findings are inconclusive, magnetic resonance imaging (MRI) or computed tomography (CT) is recommended. This review aims to discuss the most common causes of periarticular soft tissue masses in the appendicular skeleton, focusing on clinical presentation and radiologic features.
软组织肿块大多为良性，良性与恶性比例超过100:1，常位于关节周围。它们可能与关节相邻或相连，也可能反映全身性疾病或远处器官受累。临床上，它们通常表现为可触及的肿胀。评估应考虑病程、大小、深度和活动度。还要评估质地、生长速度、症状以及创伤、感染或恶性肿瘤病史。实验室检查一般诊断价值有限。主要临床目标是避免对良性病变进行不必要的检查或操作，同时确保对恶性病变及时诊断和治疗。影像学起着核心作用：它能确认病变的存在，评估其位置、大小和成分，区分囊性与实性或良性与恶性特征，有时还能提供明确诊断。影像学对于活检规划、治疗策略、确定受累结构以及随访也至关重要。超声（US）因其成本低、易于获得且无电离辐射，是可触及软组织肿块的一线影像学检查方法。如果检查结果不明确，建议进行磁共振成像（MRI）或计算机断层扫描（CT）。本综述旨在讨论四肢骨骼周围软组织肿块最常见的病因，重点关注临床表现和放射学特征。
