Presentation
Stone former with left flank pain. No nausea, vomiting or urinary symptoms.
Patient Data
A few tiny calculi measuring up to 2 mm are seen in the left kidney. Few tiny concretions/gravels are seen in the right kidney. No radiopaque calculi are seen in the ureters and partially filled urinary bladder. No hydronephroureter or perinephric fat stranding/collection is seen on either side. Multiple small phleboliths are seen in the pelvis.
Surgical sutures are seen around the stomach which are related to the previous bariatric surgery. A small well-defined benign looking lesion measuring 2.5 x 4.3 cm (average density=19HU) is noted in the superficial subcutaneous soft tissues of the right upper lumbar region at T12/L1 level. No calcifications or fat density is seen in it.
Well-defined heterogeneous echogenicity oval-shaped lesion measuring 1.9 x 3.8 cm is seen in the superficial subcutaneous soft tissues of the right lumbar region. No vascularity is seen in it on color Doppler ultrasound examination.
Histopathology report of the excised lesion shows a ruptured benign epidermoid cyst.
Case Discussion
Lesion location and imaging features are suggestive of an epidermal inclusion cyst. Mildly high fluid density contents on CT scan and sonographic appearance of soft tissue echogenicity on ultrasound may be due to mucoid contents.
On further questioning, the patient mentioned this lesion to be there for the last 4 months and was associated with mild pain. No history of fever or discharge.
The lesion was excised and sent for histopathological analysis.
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