The use of high-frequency skin ultrasound in the diagnosis of lipodermatosclerosis

Abstract

Introduction: Lipodermatosclerosis is a symptom of severe venous insufficiency, the diagnosis of which is based on the clinical picture. Although the histopathology of the skin and the subcutaneous tissue allows for the most reliable diagnosis, it is not recommended due to healing disorders. Aim: The aim of this study was to assess the usefulness of high-frequency ultrasound in the diagnosis of lipodermatosclerosis. Materials and methods: The study included 10 patients with lipodermatosclerosis who underwent Duplex Doppler ultrasound of lower limb veins, high-frequency ultrasound of the tibial skin, and radiography of the lower leg, all of which were analyzed in correlation with clinical symptoms. Results: The study group included 9 women and 1 man aged 39–81 years. Manifestations of lipodermatosclerosis were detected in 14 limbs. High-frequency ultrasound showed that the mean dermis thickness at the affected sites was 2.63 mm, and was significantly thicker compared to healthy skin (1.45 mm) (p = 0.00002). Higher echogenicity was detected in the affected body regions in 85.7% of cases for the skin and 92.9% of cases for the subcutaneous tissue. Subcutaneous and vascular wall calcifications were detected in 92.9% and 78.6% of cases, respectively. Fibrosis was observed in all limbs, and compression sonoelastography showed that the compliance of the subcutaneous tissue was lower than that of muscles. The border between the skin and the subcutaneous tissue was blurred in 57.1% of cases. Radiography revealed thickening of the affected skin regions in all limbs, with calcifications detected in 85.7% of cases. A blurred border between the skin and the subcutaneous tissue was observed in 35.7% of limbs. Conclusion: High-frequency ultrasonography of the skin and the subcutaneous tissue in the lower legs supported with radiological findings is highly useful in the diagnosis of lipodermatosclerosis.

Sun Sign in the Ultrasound Diagnosis and Activity Assessment of Morphea

“…At the mid (sclerotic‐predominant) stage with deep involvement, differential diagnoses include the chronic phase of lipodermatosclerosis; chronic graft‐versus‐host disease; late eosinophilic fasciitis; porphyria cutanea tarda, and dermatofibrosarcoma protuberans, among others. Differential diagnoses of the late stage of morphea with dermal involvement include late mycosis fungoides; late lichen sclerosus; acrodermatitis chronica atrophicans, vitiligo, late lichen plano pilaris; late lupus erythematosus profundus; lipodystrophy: intramuscular or intralesional corticosteroid injection and fat atrophy secondary to trauma 8–11 …”

“…Differential diagnoses of the late stage of morphea with dermal involvement include late mycosis fungoides; late lichen sclerosus; acrodermatitis chronica atrophicans, vitiligo, late lichen plano pilaris; late lupus erythematosus profundus; lipodystrophy: intramuscular or intralesional corticosteroid injection and fat atrophy secondary to trauma. [8][9][10][11] Nevertheless, to date, there are reports on the ultrasonographic appearance of some of these conditions such as vascular malformations, lipodermatosclerosis, eosinophilic fasciitis, keloids, chronic graft versus host disease, lipodystrophy, mycosis fungoides, and dermatofibrosarcoma protuberans. Eosinophilic fasciitis and chronic graft versus host disease present some similar ultrasonographic findings to morphea, which support the hypothesis that these entities may be variants of the presentation of morphea.…”

Assessment of skin and associated soft tissue changes with ultrasonography in chronic venous disease

“…In addition, identifying these changes in the early stages will help stratify their management to reduce disease progression and morbidity. [12][13][14][15][16] This study has highlighted the role of skin US in the management of these patients. Incorporating the US for evaluating skin changes in CVD in the surgical clinic will help develop insight into the pathophysiology of skin changes and help select patients for appropriate intervention based on the US findings by separating those patients that need medical attention with cosmetic problems alone.…”

“…In addition, identifying these changes in the early stages will help stratify their management to reduce disease progression and morbidity. 12–16…”

Ultrasonographic study of the effects of compressive stockings on legs with venous edema

“…8 These findings were then supported by other authors who evaluated the tissue changes in legs with venous edema by US. [9][10][11][12][13][14] The purpose of this study was to evaluate the effects of medical compression stockings (MCS) on the US morphology of the cutaneous and subcutaneous layers (CL and SCL, respectively) in legs with venous edema. Their knowledge could contribute to explain the mechanism of action of MCS in counteracting venous signs and symptoms of CVD as well as in preventing disease progression and recurrence.…”