Vascular lesions and vascular mimickers in musculoskeletal ultrasound: a practical pattern-based diagnostic approach

Vascular abnormalities encountered during musculoskeletal ultrasound examinations encompass a broad spectrum of entities, including vascular tumors, vascular malformations, inflammatory hyperemia, traumatic vascular injuries, and several non-vascular lesions that may mimic vascular pathology. Accurate characterization is essential to avoid diagnostic errors and inappropriate management. This review is supplemented by illustrative ultrasound and Doppler images from our clinical experience, selected to demon-strate the characteristic imaging features of vascular lesions and their principal mimickers. Lesions were analyzed based on morphology, vascularity, compressibility, flow characteristics, and clinical presentation. Characteristic ultrasound patterns allow most vascular findings to be categorized into four major groups: true vascular lesions, hypervascular tumors, hemorrhagic lesions, and inflammatory processes. High-resolution ultrasound combined with Doppler evaluation enables differentiation between low-flow and high-flow vascular abnormalities and provides valuable information about lesion extent, hemodynamic behavior, and relationships with adjacent structures. Particular attention is given to subtle findings that may overlap among different entities, as well as to practical clues that can help guide further imaging or clinical management when ultrasound findings remain indeterminate. Dynamic assessment and clinical history significantly improve diagnostic confidence. This educational review presents a practical ultrasound-based approach to evaluating vascular and vascular-like soft-tissue lesions, emphasizing imaging features and clinical correlation.