Designed for early-career sonographers, this presentation is designed to build confidence in assessing palpable soft-tissue lesions. We will explore the distinguishing features of both common and not so commonly encountered lumps and bumps, with a focus on key clinical and physical findings. Through practical examples and case studies, we will share a foundational approach to evaluating soft-tissue lesions, equipping sonographers with skills to recognise patterns, identify red flags, and approach palpable masses with greater certainty.

Designed for early-career sonographers, this presentation is designed to build confidence in assessing palpable soft-tissue lesions. We will explore the distinguishing features of both common and not so commonly encountered lumps and bumps, with a focus on key clinical and physical findings. Through practical examples and case studies, we will share a foundational approach to evaluating soft-tissue lesions, equipping sonographers with skills to recognise patterns, identify red flags, and approach palpable masses with greater certainty.

Familial Hypercholesterolaemia (FH) is a common hereditary lipid disorder associated with markedly elevated LDL‑cholesterol and a high burden of premature cardiovascular disease. Achilles tendon xanthoma (ATX), a characteristic feature of FH, may present as tendon thickening or as a focal hypoechoic nodule, yet clinical examination frequently misses subtle or early morphological changes. This paper explores the role of ultrasound in identifying ATX among patients with probable or definite FH attending a specialist lipid clinic. In this cohort, Achilles ultrasound was performed using a high‑frequency linear transducer and compared directly with physical examination findings. Ultrasound consistently demonstrated typical features that included diffuse thickening, fusiform enlargement, and discrete hypoechoic nodules, even when tendons appeared clinically normal. Overall, ultrasound detected a substantially higher prevalence of ATX than physical examination and improved the clinical classification of FH severity. These findings highlight the value of ultrasound in supporting more accurate cardiovascular risk assessment in FH.