образование мягких тканей

после травмы (укус) возможно развитие оссифицирующего миозита, а также различных опухолевидных мягкотканных образований, можно рекомендовать пункционную биопсию для уточнения характера патологии и узи в динамике через месяц.

после нематод в мошонке только гельминты на ум приходят...

На паразиты не похоже.Скорее всего рубцовые изменения в мышечной ткани

Для ребенка 10 лет образование достаточно больших размеров с четкой капсулой. Нужно удалить и определиться с гистологией. Если так и будет, узнайте пожалуйста, что же это на самом деле и выложите в блоге.

Выскажусь в пользу оссифицирующего миозита, но в любом случае дифференцировать с опухолью. Цитата ниже: Stefano Bianchi, Carlo Martinoli «Ultrasound of the Musculoskeletal System», Springer-Verlag Berlin Heidelberg 2007, p. 57-59. Перевести, я думаю, труда не составит. Там и про сроки и про дифференциальную диагностику достаточно чётко написано. There are three main complications of muscle tear: cysts and myositis ossificans and, more rarely, cal- cific myonecrosis (Peetrons 2002). Intermuscular and intramuscular cysts may be encountered after muscle trauma as well-defined echo-free masses with posterior acoustic enhancement. These cysts have an elongated shape and represent the residue of a local hematoma. Their most common location is the calf (see Chapter 15). In selected cases, they may require percutaneous needle evacuation. Calcific myonecrosis is a space-occupying calcified mass that typically develops in the anterior compart- ment of the leg late after a closed lower extremity trauma, and is often seen in association with vascu- lar injury or a compartment syndrome (Dhillon et al. 2004). In this condition, the injured muscle may be replaced with a complex mass consisting of a central cystic core containing necrotic muscle, fibrin, cholesterol, and organizing thrombus, together with a peripheral calcified rim. US demonstrates calcified myonecrosis as an intramuscular extensive calcified mass with posterior acoustic shadowing and may help to guide the aspiration of the fluid component as an aid in management (Batz et al. 2006). The main differential diagnosis of calcific myonecrosis is the more common myositis ossificans, given the fact that the extensive calcified shell may mask the internal fluid component at US examination. Myositis ossificans is a benign self-limiting condition presenting as an intramuscular mass with pre- dominant involvement of the large muscles of the extremities, the large muscles of the thigh and the anterior muscles of the arm being the most commonly affected (Thomas et al. 1991). The term “myositis” is a misnomer because this condition is not inflammatory. It usually results from a severe contusion trauma or chronic microtrauma, but may also be seen in patients with other disease or may develop spontaneously. There is, however, debate as to whether unrecollected trauma is present in these cases. From the histologic point of view, this condition exhibits a typical maturation pattern that allows a proliferative mesenchymal response (early pseudosarcomatous phase) to evolve toward formation of heterotopic mature bone. During maturation of the lesion, a zonal pattern develops with three concentric zones: the inner zone is char- acterized by areas of hemorrhage and necrotic muscle with proliferating fibroblasts; the middle zone consists of immature osteoid formation and islets of cartilage preceding bone formation; and the outer zone is formed by mature bone (Gindele et al. 2000). Peripheral bone formation usually starts 6–8 weeks after the trauma, but it can occur earlier. In the late phase, the lesion can ossify as a whole with formation of a cortex and marrow spaces (Ackermann 1958). As it matures the lesion regresses in size, disappearing spontaneously in approximately 30% of cases (Schulte et al. 1995). Development of peripheral calcifications is a peculiar feature of myositis ossificans and makes this condition more easily diagnosed with X-ray modalities, including plain films and CT, than with US and MR imaging. In the early stages of disease (before the sixth week of evolution), when formation of calcifications has not yet occurred, the imaging diagnosis is not straightforward: it can be difficult to distinguish lesions at this stage from a soft-tissue malignancy. The US findings of myositis ossificans change with the lesion’s age, reflecting the evolving histology (Fornage and Eftekhari, 1989; Peck and Metreweli, 1988). Initially, the US appearance of myositis ossificans has been described as that of an intramuscular hypoechoic ovoid mass with an echogenic center, and even a so-called zone phenomenon matching the maturation process has been reported (Kramer et al. 1979; Thomas et al. 1991; Gindele et al. 2000). In more detail, early lesions are characterized by a peripheral thin hypoechoic zone enveloping a broader highly reflective zone within which a third central hypoechoic zone is found (Fig. 3.16a) (Thomas et al. 1991). With progressive maturation, the peripheral hypoechoic rim may become hyperechoic as a result of increasing ossification: a sheet-like or eggshell-like calcified rim is considered very suggestive of myositis ossificans (Peck and Metreweli, 1988). Then, visualization of the lesion center and the separation of the lesion from the underlying bony cortex may become more difficult because of the acoustic shadowing from peripheral calcifications (Gindele et al. 2000). The process of ossification is apparent with US approximately 2 weeks earlier than with plain radiographs (Peetrons 2002). Although the typical pattern of calcifications is characteristic, we believe that a standard radiograph must always be obtained to confirm the diagnosis and to exclude more aggressive calcified lesions, including paraosteal and soft-tissue sarcomas (Fig. 3.16b,c). After surgical resection, US has proved able to detect recurrence of myositis ossificans and to differentiate this condition from extraosseous sarcomas (Okayama et al. 2003).

узнаю обязательно дальнейшую "судьбу"- отпишусь

спасибо большое за статью)

Необходима пункционная биопсия толстой иглой. На снимке есть усилением эхосигнала, неоднородная структура содержимого внутри инкапсулированного образования. Скорее всего - свернувшаяся гематома с формированием капсулы. В зависимости от результата пункции (жидкое или тканевое содержимое) - вскрытие или иссечение образования.

Организовав гематома. Динамтка при сомнении ТАБ

Я так думаю,что это межмышечная организовавшаяся гематома.

Есть ли локусы артериального и венозного кровотока в образовании?А по периферии какой кровоток? Гематома бывает появляется и отсроченно,уж очень похоже на гематому в стадии организации.Если нет кровотока.Что касается капсулы,то она слишком толстая для опухоли доброкачественной.Что касается опухоли злокачественной,то приходилось видеть у детей саркому после травмы,она без капсулы и мышечная структура все же прослеживается,хоть и дезорганизованная.

Организовавшаяся гематома. С травмой мягких тканей сталкиваюсь часто, картинка характерная. И еще добавлю как старый собаковод: бщепринятое выражение - укус собаки не не соответствует характеристике травмы. Собака не кусает, а бьёт зубами и при не поврежденных кожных покровах или незначительных повреждениях, в глубоких слоях травма мягких тканей по типу размозжения, Если не беспокоит трогать не надо, можно понаблюдать в динамике, не так-то просто убрать это образование из мышцы