Case for diagnosis. Subcutaneous nodules in the plantar region

Abstract

The authors report a case of mobile and painful nodules on the bilateral plantar surface of a female patient referred by the rheumatology service, where she was being followed-up for rheumatoid arthritis. A nodule excision was performed for differential diagnosis and symptom relief; the histopathological analysis was compatible with a rheumatoid nodule. Although rheumatoid nodules are a common manifestation of rheumatoid arthritis, exclusive plantar involvement is seldom described in the literature.

Trombosis venosa plantar subcutánea y la importancia de su diagnóstico por ultrasonido: serie de casos

“…El diagnóstico diferencial de los nódulos plantares incluye cuerpos extraños, verrugas, fibromatosis plantar, nódulos reumatoideos, granulomas, quistes cutáneos, lipomas, depósitos de cristales, hiperqueratosis, hematomas, quistes epidérmicos plantares, leiomiomas y schwannomas, entre otros 1,3,6 , sin embargo, a diferencia de la mayoría de estos, la TVPS no suele sospecharse clínicamente, siendo su principal característica el presentarse como nódulo palpable y doloroso 1,3,5,6 . Clínicamente el diagnóstico diferencial es amplio, sin embargo la TVPS tiene hallazgos al US característicos, que se asemejan a los hallazgos encontrados en la trombosis venosa de otras ubicaciones y permiten confirmar el diagnostico 7 , haciendo a esta modalidad imagenológica el método de elección para su diagnóstico, destacando como características la ubicación en plano subcutáneo superficial, ausencia de vascularización interna inicial al modo Doppler, y comunicación con venas subcutáneas que suelen estar dilatadas 6 .…”

“…Existen múltiples etiologías que se consideran habitualmente en el diagnóstico diferencial del dolor plantar, tanto por clínicos como por radiólogos; dentro de estas etiologías solo algunas se presentan como nódulos plantares palpables y dolorosos, sin embargo, uno de los diagnósticos diferenciales que ha sido escasamente descrito en la literatura [1][2][3][4][5][6] , y que en los casos reportados hasta la fecha no se ha sospechado clínicamente, es la trombosis venosa plantar subcutánea (TVPS). Esta es una enfermedad cuyo diagnóstico es eminentemente ultrasonográfico y presenta características específicas 6 .…”

Subcutaneous plantar vein thrombosis and the importance of its diagnosis by ultrasound: case series

“…The differential diagnosis of plantar nodules includes foreign bodies, warts, plantar fibromatosis, rheumatoid A B nodules, granulomas, skin cysts, lipomas, crystal deposits, hyperkeratosis, hematomas, plantar epidermal cysts, leiomyomas, and schwannomas, among others. 1,3,6 However, unlike most of these, SCPVT is not usually suspected clinically, its main characteristic being that it presents as a palpable and painful nodule 1,3,5,6 . Clinically, the differential diagnosis is broad; however, SCPVT has characteristic US findings, which are similar to the findings found in venous thrombosis in other locations and allow us to confirm the diagnosis 7 , making this imaging modality the method of choice for its diagnosis, highlighting as characteristics the location in the superficial subcutaneous plane, absence of initial internal vascularization in Doppler mode, and communication with subcutaneous veins that are usually dilated 6 .…”

“…There are multiple etiologies that are usually considered in the differential diagnosis of plantar pain, both by clinicians and radiologists; within these etiologies, only some present as palpable and painful plantar nodules; however, one of the differential diagnoses that have been scarcely described in the literature [1][2][3][4][5][6] , and that has not been clinically suspected in the cases reported to date is subcutaneous plantar vein thrombosis (SCPVT). This is a disease whose diagnosis is eminently ultrasonographic and presents specific characteristics 6 .…”