Woźniak Witold, Danowska Anna, Mlosek Robert K
First Department of General and Vascular Surgery, Faculty of Medicine, Medical University of Warsaw, Poland.
Ultrasound Diagnostic Department Faculty of Medical Sciences, Medical University of Warsaw, Warsaw, Poland.
J Ultrason. 2021;20(83):e284-e290. doi: 10.15557/JoU.2020.0050. Epub 2020 Dec 18.
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.
The aim of this study was to assess the usefulness of high-frequency ultrasound in the diagnosis of lipodermatosclerosis.
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.
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) ( = 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.
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.
脂膜炎性硬化是严重静脉功能不全的一种症状，其诊断基于临床表现。尽管皮肤和皮下组织的组织病理学检查可实现最可靠的诊断，但由于愈合障碍，不建议采用。
本研究旨在评估高频超声在脂膜炎性硬化诊断中的应用价值。
该研究纳入了10例脂膜炎性硬化患者，对其下肢静脉进行了双功多普勒超声检查、对胫骨皮肤进行了高频超声检查，并对小腿进行了X线摄影，所有检查均与临床症状相关联进行分析。
研究组包括9名女性和1名男性，年龄在39至81岁之间。在14条肢体中检测到脂膜炎性硬化表现。高频超声显示，受累部位的真皮平均厚度为2.63毫米，与健康皮肤（1.45毫米）相比明显更厚（P = 0.00002）。在85.7%的皮肤病例和92.9%的皮下组织病例中，受累身体区域检测到更高的回声。分别在92.9%和78.6%的病例中检测到皮下和血管壁钙化。在所有肢体中均观察到纤维化，压缩弹性成像显示皮下组织的顺应性低于肌肉。在57.1%的病例中，皮肤与皮下组织之间的边界模糊。X线摄影显示所有肢体中受累皮肤区域增厚，在85.7%的病例中检测到钙化。在35.7%的肢体中观察到皮肤与皮下组织之间的边界模糊。
结合放射学检查结果，对小腿皮肤和皮下组织进行高频超声检查在脂膜炎性硬化的诊断中非常有用。
