valuation of the skin and subcutaneous tissue is one of the most recent and impressive achievements of sonography; the availability of very high resolution probes (10 to 20 MHz) makes possible excellent images with exquisite anatomic details, including an accurate definition of the various layers of the skin. 1 Nodular lesions of the skin are a frequent and possibly serious dermatologic problem, because some of the most aggressive neoplasms originate from the skin (melanoma, lymphoma) and are manifested as small nodules indistinguishable from benign ones. High-frequency ultrasonography has been employed extensively in this field, but its lack of specificity (many nodular lesions share the same sonographic appearance) suggests that the method may be useful only when a morphologic description of an already diagnosed malignancy is needed.Color Doppler interrogation is able to increase the specificity of sonography by providing real-time evaluation of vascularity, which is an important clue in distinguishing benign from malignant lesions; malignant tumors show an increased number of vessels, which generally appear tortuous, deformed, and displaced. The recent availability of highresolution probes with color Doppler capability is opening the field of vascular evaluation to dermatologic disease, with a potential diagnostic impact that is as yet mostly unexplored.The aim of this work was to explore the potentiality of color Doppler technique to increase the specificity of ultrasonography in characterizing nodular lesions of the skin and subcutaneous tissue. The sensitivity and specificity of hypervascularity in malignant lesions were 90% and 100%, respectively, whereas the sensitivity and specificity of hypovascularity in benign lesions were 100% and 90%, respectively. The authors conclude that color Doppler sonography is able to increase the specificity of ultrasonography in the evaluation of nodular lesions of the skin.

The presence of peripheric subcapsular vessels, which is typical of metastasis, is definitely rare in lymphoma (with the possible exception of the uncommon subtypes of high-grade lymphomas). The differential diagnosis between lymphoma and lymphadenitis is frequently impossible on the basis of sonographic and color Doppler patterns alone; therefore, clinical evaluation and biopsy are generally mandatory.

Ultrasonography (US) is an efficient alternative to magnetic resonance (MR) imaging for evaluation of soft tissues of the elbow. US is able to diagnose several abnormalities affecting tendons, muscles, ligaments and bursae around the elbow joint. In cubital tunnel syndrome, US identifies ulnar nerve abnormalities and extrinsic lesions that may cause nerve entrapment. Occult fractures, osteophytes and intra-articular loose bodies can also be imaged. In para-articular swelling, US is able to assess the presence of capsular and synovial processes and to differentiate them from soft tissue tumors. Key advantages of this technique include cost-effectiveness, availability and ability to perform a dynamic examination.

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KEYWORDSGastrocnemius muscle; Ultrasonography; Tennis leg.Abstract Purpose: The aim of this study is to demonstrate the diagnostic accuracy of ultrasonography (US) in the diagnosis of rupture of the medial head of the gastrocnemius muscle, also called ''tennis leg'' (TL). Materials and methods: Thirty-five consecutive patients with acute traumatic injury of the calf underwent US examination. There were 25 men and 10 women; mean age 47.5 years (range 35e60 years). All examinations were performed using a 5e12 MHz broadband electronic linear array probe. Results: Thirty-three out of 35 patients had TL; 24 cases of partial rupture and nine cases of complete rupture were diagnosed. In the remaining two cases, both with symptoms suggesting TL, one patient had a tear of the proximal musculotendinous junction and one had a ruptured Baker's cyst. Fluid collections caused by the muscular rupture were visible as hypoechoic areas; in 80% of cases associated by a hyperechoic oval area due to hematoma and local inflammation. The degree of fluid collection in the patients with complete rupture (6e16 mm; mean: 9.7 mm) was significantly greater than the one seen in patients with partial rupture (4e8 mm; mean: 6.8 mm). Conclusions: US is the imaging modality of choice in clinical suspicion of TL, both in the initial workup of the patient and in the follow-up. US is easy to perform and is particularly useful to distinguish TL from other pathologies, especially ruptured Baker's cyst and deep vein thrombosis, which require a different therapeutic management.Sommario Scopo: L'obiettivo di tale studio è dimostrare l'accuratezza diagnostica dell'ecografia nella diagnosi della rottura del ventre mediale del muscolo gastrocnemio (Tennis Leg). Materiali e metodi: Sono stati valutati con esame ecografico 35 pazienti (25 uomini e 10 donne, con un range di età tra i 35 e i 60 anni ed età media di 47,5 anni) con danno acuto traumatico del polpaccio. Gli esami sono stati effettuati usando una sonda elettronica lineare a banda larga da 5e12 MHz. Risultati: Trentatre dei 35 pazienti presentavano una rottura del ventre mediale del muscolo gastrocnemio (TL): 24 rotture parziali e 9 rotture complete. Nei rimanenti due casi, entrambi con sintomi clinici suggestivi di Tennis Leg, sono stati diagnosticati strappo della giunzione prossimale muscolo-tendinea e rottura di una cisti di Baker. La raccolta fluida, conseguenza della rottura muscolare, si presentava come una zona ipoecogena, con area iperecogena ovalare nel contesto, riferibile a ematoma e alla flogosi locale. L'entità della raccolta fluida nei pazienti con rottura completa (6e16 mm; media: 9.7) era significativamente superiore rispetto ai pazienti con rottura parziale (4e8 mm; media: 6.8).Conclusioni: L'ecografia è l'indagine di prima scelta nel sospetto clinico di rottura del ventre mediale del muscolo gastrocnemio, non solo per la rapidità di esecuzione e per il follow-up, ma soprattutto per la possibilità di fare diagnosi differenziale con altre patologie, prime tra tutte la rottura di ci...