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Angiomyolipoma seen as a hyperechoic mass in the upper pole of an adult kidney on renal ultrasonography. Renal ultrasonography of a person with tuberous sclerosis and multiple angiomyolipomas in the kidney: Measurement of kidney length on the US image is illustrated by '+' and a dashed line. CT scan of a renal angiomyolipoma.
For a lesion diameter below 10 mm US accuracy is greatly reduced, reaching approx. 20%. Other elements contributing to lower US performance are: excessive obesity, fatty liver disease, hypomobility of the diaphragm, and certain patterns of hyperechoic or isoechoic metastases that can be overlooked or can mimic benign conditions.
Angiomyofibroma are often found in patients with tuberous sclerosis. They are composed of fat, smooth muscle tissue and vascular elements. The echogenicity is governed by the composition of these elements, but the lesion is often hyperechoic (Figure 11 and Figure 12). [1] Benign tumors are difficult to separate from malignant tumors using US.
Features of benign lesion are: hyperechoic, having coarse, dysmorphic or curvilinear calcifications, comet tail artifact (reflection of a highly calcified object), absence of blood flow in the nodule, and presence of cystic (fluid-filled) nodule. However, the presence of solitary or multiple nodules is not a good predictor of malignancy.
Tissues that have higher echogenicity are called "hyperechoic" and are usually represented with lighter colors on images in medical ultrasonography. In contrast, tissues with lower echogenicity are called "hypoechoic" and are usually represented with darker colors.
A sclerotic lipoma is a predominantly fibrous lesion with focal areas of fat. [12] Neural fibrolipomas are overgrowths of fibro-fatty tissue along a nerve trunk, which often leads to nerve compression. [7]: 625
At ultrasound, lipoma is a well–defined, homogeneous, hyperechoic paratesticular lesion of varying size [Fig. 14]. The simple finding of an echogenic fatty mass within the inguinal canal, while suggestive of a lipoma, should also raise a question of fat from the omentum secondary to an inguinal hernia.
The lesion develops in two distinct stages with different presentations at US. [7] In the early stage, termed immature, it depicts a non-specific soft tissue mass that ranges from a hypoechoic area with an outer sheet-like hyperechoic peripheral rim to a highly echogenic area with variable shadowing.