Ultrasonographic Characteristics of Lingual Schwannomas: A Retrospective Observational Study

To characterize the multimodal ultrasonographic features of lingual schwannomas and evaluate their diagnostic value in clinical practice.

This retrospective study included five patients with histopathologically confirmed lingual schwannomas treated between 2018 and 2020. All patients underwent preoperative grayscale ultrasound and Color Doppler Flow Imaging, and contrast-enhanced ultrasound (CEUS) was additionally performed in one patient. Sonographic features-including lesion location, morphology, echogenicity, posterior acoustic characteristics, capsule presence, vascularity (Adler scale), spectral Doppler parameters, and CEUS enhancement patterns-were analyzed.

All lesions (mean maximum diameter, 15.6 ± 2.7 mm) were located within the intrinsic musculature of the tongue. Grayscale ultrasound exhibited well-defined, homogeneous hypoechoic masses with posterior acoustic enhancement and oval or ellipsoid morphology. A distinct capsule was observed in three cases. Color Doppler imaging demonstrated low intralesional vascularity, with four lesions classified as Adler Grade 1 and one as Grade 2. Spectral Doppler demonstrated high-resistance arterial flow (resistive index, 0.69-0.81). In the representative case examined with CEUS, the lesion exhibited slow wash-in and slow wash-out with homogeneous centrifugal enhancement and clear delineation from surrounding tissues.

Lingual schwannomas in this series exhibited a set of recurrent ultrasonographic features that may aid preoperative diagnosis and support ultrasonography as a first-line imaging modality.