Utilization of Ultrasonography in Dermatology: Two Case Reports of Calcinosis Cutis

Abstract

Development of newer generation of cost-effective ultrasonic devices in recent years has increased the use of ultrasonography in dermatology. Several lesions can be diagnosed and managed using ultrasonography. Calcinosis cutis involves the deposition of insoluble calcium salts in the cutaneous and subcutaneous tissues. On ultrasonography, it specifically presents as hyperechoic deposits with a posterior acoustic shadowing artifact due to the acoustic properties of calcium. A 62-year-old female patient presented with a solitary, skin-colored, palpable nodule on the inner side of the right lower leg. The lesion was beneath the intact skin and detectable only on palpation. However, ultrasonography demonstrated a clear delineation of the lesion, showing hyperechoic deposits with a posterior acoustic shadow (15 MHz, linear probe). Skin biopsy and curettage were performed, revealing histological features consistent with calcinosis cutis. Four weeks after the procedure, ultrasonography performed to evaluate the outcome of treatment, showed recurrence. Another 18-year-old female patient presented with a skin-colored deep-seated nodule on the left temple. On ultrasonography, linear hyperechoic deposits with a posterior acoustic shadow were visible. Skin biopsy was performed, and histopathologic features showed calcified material in the subcutaneous tissue. These two cases of calcinosis cutis highlight the diagnostic value of ultrasonography in dermatology.

Updated solution for diagnosis and management of calcinosis cutis: A retrospective review

“…[14] Meanwhile, ultrasonography specifically presents hyperechoic deposits with a posterior acoustic shadowing artifact, owing to the acoustic properties of calcium. [4] It can provide a more precise assessment of the location, size, and relationship of the mass with the surrounding tissues.…”

“…[3] To diagnose calcinosis cutis, the patient's medical history and laboratory findings are evaluated to examine associations with connective tissue diseases or metabolic imbalances. [4] Usually, imaging studies, such as plain radiography, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), can be valuable for identifying the location and extent of calcium deposits. [4] However, while physical examination and radiological findings can provide localization information, a definitive diagnosis necessitates a biopsy and subsequent histopathological examination.…”

“…[4] Usually, imaging studies, such as plain radiography, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), can be valuable for identifying the location and extent of calcium deposits. [4] However, while physical examination and radiological findings can provide localization information, a definitive diagnosis necessitates a biopsy and subsequent histopathological examination. [4] Given the lack of a standard method for diagnosing calcinosis cutis prior to surgery, clinical diagnosis of calcinosis cutis is often achieved through time-consuming histopathological or immunohistochemical procedures.…”

“…[4] However, while physical examination and radiological findings can provide localization information, a definitive diagnosis necessitates a biopsy and subsequent histopathological examination. [4] Given the lack of a standard method for diagnosing calcinosis cutis prior to surgery, clinical diagnosis of calcinosis cutis is often achieved through time-consuming histopathological or immunohistochemical procedures. [5] Consequently, this condition is frequently misdiagnosed as skin conditions such as pilomatrixoma, juvenile xanthogranuloma, molluscum contagiosum, and malignancy.…”