Contributed by
University Hospital of Leuven
Frederik Van den Kerkhof, Lone Limantoro, and Caroline Colmant.
History
A two-month-old boy was referred for a second opinion and ultrasound to evaluate a bluish subcutaneous mass on the right flank with initial clinical and ultrasonographic suspicion of a vascular lesion. Before scanning, we turned on the lights to have a closer look at the lesion. A painless blue-red nodular lesion was noted. This nodule was very hard, not typical of an infantile hemangioma, which should prompt the radiologist to keep this in mind during ultrasound interpretation.
During the consultation with the dermatologist, the mother mentioned that an asymptomatic violaceous macula had been present since birth. Over time, a palpable subcutaneous lesion developed beneath it. The child was otherwise healthy with normal growth and development. Dermatological examination revealed a subcutaneous mass adherent to the overlying skin but mobile over the deeper planes, with a very firm consistency, topped by a violaceous discoloration of the skin without any epidermal changes. No additional cutaneous abnormalities were observed, aside from a superficial infantile hemangioma on the right thigh.
The subsequent ultrasound demonstrated a well-circumscribed hypoechoic nodule of approximately 13 mm in the dermis without posterior enhancement. There was only limited peripheral vascularity and a small arterial vessel deep to the lesion.
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