Imaging Evaluation of Periarticular Soft Tissue Masses in the Appendicular Skeleton: A Pictorial Review

TL;DR

This paper reviews how to use imaging to evaluate soft tissue masses near joints, focusing on distinguishing benign from malignant cases.

Contribution

The paper provides a pictorial review of the most common causes of periarticular soft tissue masses in the appendicular skeleton.

Findings

Soft tissue masses are mostly benign with a benign-to-malignant ratio exceeding 100:1.

Ultrasound is the first-line imaging modality for palpable soft tissue masses due to its low cost and lack of radiation.

Imaging is crucial for diagnosis, biopsy planning, treatment strategy, and follow-up.

Abstract

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.

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