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Subcutaneous lesions often raise diagnostic doubts in the dermatological consultation and require a more specific approach. We describe a case in which skin ultrasound played a fundamental role in the diagnosis and management of a patient with a neck tumor. The patient was a 20-year-old woman with no personal medical history of interest who was seen for a progressively growing tumor in the left cervical region that had appeared suddenly 1 week earlier, causing mild pain in the immediate area of the lesion. Physical examination revealed a subcutaneous lesion (3 × 2 cm) with a gummy consistency, with no alteration in surface coloration and no epidermal involvement (Fig. 1). The differential diagnosis included adenopathies, lipoma, intramuscular hematoma, and other subcutaneous tumors. Given the diagnostic doubt, the patient underwent skin ultrasound with a 15--18--MHz linear probe (Esaote MyLab), which revealed the presence beneath the sternocleidomastoid muscle of a hypoechoic, oval structure (2.8 × 1.5 × 1.4 cm) with well-defined margins and a major axis in the longitudinal direction. Color Doppler mode showed an absence of intralesional vascularization and the presence of peripheral vascularization (Figs. 2 and 3). The ultrasound findings were compatible with an intramuscular hematoma. In light of the ultrasound findings, we further investigated the medical history of the patient, who reported that she had visited a chiropractor 2 weeks earlier.

Lesión subcutánea cervical tras manipulación quiropráctica: papel de la ecografía cutánea