Textbook of Dermatologic Ultrasound

Foreword
Preface
Acknowledgments
Contents
Contributors
Part I: The Requisites
1: Technical Recommendations, Settings, Protocols, Training, and Reports of the Dermatologic Ultrasound Examinations
Introduction
Recommendations and Relevant Points
How to Improve the Learning of Dermatologic Ultrasound
Protocols for Performing Dermatologic Ultrasound Examinations
Sedation
Technique for the Dermatologic Ultrasound Examination
Training of Dermatologic Ultrasound
Main Concepts
Assessment of Competence and Operators in Charge of the Examination
Major Advantages of the Dermatologic Ultrasound Examinations
Major Limitations
Main Applications
Reporting the Examinations
Common Issues in Dermatologic Ultrasound
Special Protocols
Protocol for the Nail
Protocol for the Scalp
Protocol for Patients with History of Aesthetic Procedures of the Face
Protocol for Hidradenitis Suppurativa
Protocol for Morphea
Other Useful Tips
Settings for Dermatologic Lesions
Conclusion
References
2: Training in Dermatologic Ultrasound
Introduction
Towards a Structured Curriculum for Dermatologic Ultrasound Teaching
Practical Considerations Regarding Course Organization in Dermatologic Ultrasound
Dermatologic Ultrasound According to Academic Degree or Specialization
Pregrade Medicine Students
Dermatology and Radiology Residents
Dermatologic Ultrasound for Specialists
Dermatologic Ultrasound for Primary Care Practitioners
Accreditation in Dermatologic Ultrasound
Conclusions
References
3: Dermatologic Concepts and Terminology
Initial Approach to Skin Lesions
Dermatopathological Terms
Glossary of Common Dermatologic Disorders
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
R
S
T
U
V
W
X
Common Dermatologic Signs
Differential Diagnosis of Skin Disorders According to Lesion Morphology and Affected Region
Relevant Scoring Systems in Dermatology
Hidradenitis Suppurativa
Malignant Melanoma
Psoriasis
Atopic Dermatitis
Toxic Epidermal Necrolysis/Stevens-Johnson Syndrome
Systemic Sclerosis
Lupus Erythematosus
References
4: Ultrasound Imaging: Basic Principles and Terminology
Introduction
Basic Acoustics and Instrumentation
Grayscale Ultrasound Imaging
Doppler Sonography
Ultrasound Transducers
Software Developments
Tissue Harmonic Imaging
Spatial Compounding Imaging
Extended Field of View (EFOV)
Three-Dimensional (3D) Imaging
Elastography
Contrast-Enhanced Ultrasound
Microvascularity
Fusion Imaging
Operator Performance
Future Directions
Tips and Teaching Points
Useful Glossary of Ultrasound
Conclusion
References
5: Comprehensive Ultrasonographic Anatomy of the Normal Skin, Nail, Hair, and Adjacent Structures
Introduction
Skin
Hair
Additional Structures Detected at Ultrahigh Frequency (70 MHz)
Arrector Pili Muscle
Sebaceous Glands
Montgomery Glands
Apocrine Glands
Nail
Adjacent Normal Structures
Lymph Nodes
Muscle
Tendons
Joints
Bursae
Nerves
Cartilage
Vessels
Glands
Mammary Glands
Bone Calcium
Conclusion
References
6: Relevant Topographic Anatomy of the Head, Anatomical Variants, and Risk Zones
Introduction
Relevant Topographic Anatomy of the Head
Facial Anatomy
Muscles of the Face
Eyelids
Nose
Lips
Ear
Anatomical Variants
Salivary Glands
Main Arteries: Facial, Angular, Labial, Alar, Supratrochlear, Supraorbital, Infraorbital
Relevant Risk Zones of the Head
Glabellar Region
Temple and Lateral Part of the Frontal Region
Parietotemporal Region
Preauricular Region
Infraorbital Region
Nasofold Region
References
Part II: Ultrasound Features of Common Dermatologic Conditions
7: Ultrasound of Congenital Cutaneous Conditions
Introduction
Congenital Cutaneous Conditions
Vascular Origin
Congenital Hemangiomas
Rapidly Involuting (RICH)
Non-involuting (NICH)
Partially Involuting (PICH)
Other Ultrasonographic Features of Congenital Hemangiomas
Vascular Malformations (VMs)
Congenital Syndromes with Vascular Malformations
Cysts
Branchial Cysts or Fistulas
Thyroglossal Cysts
Dermoid Cysts
Auricular Pits and Fistulas (Sinuses)
Aplasia Cutis Congenita (ACC)
Nevus Sebaceous of Jadassohn (NSJ)
Neurofibromatosis (NF)
Lipofibromatous Hamartoma
Ichthyosis
References
8: Nonvascular Benign Tumors and Pseudotumors
Introduction
Nonvascular Benign Tumors and Pseudotumors
Cystic
Epidermal or Inclusion Cyst
Trichilemmal Cyst
Pilonidal Cyst
Nodular Hidradenoma
Hidrocystoma
Chalazion
Steatocystoma Multiplex
Solid
Lipoma
Pilomatrixoma
Dermatofibroma
Nodular Fasciitis
Nodular Pseudolymphoma
Keloids
Conclusion
References
9: Essential Concepts on Ultrasonography of Skin Cancer
Introduction
Non-melanoma Skin Cancers
Basal Cell Carcinoma (BCC)
Squamous Cell Carcinoma (SCC)
Dermatofibrosarcoma Protuberans (DFSP)
Merkel Cell Tumor
Primary Cutaneous Lymphomas
Liposarcomas
Melanoma
References
10: Ultrasound of Cutaneous Melanoma: Primary Tumor Assessment and Locoregional Staging
Introduction
Epidemiological and Clinical Aspects of Cutaneous Melanoma
Prevalence and Mortality
Pathology and Classification: The Breslow Index
Patterns of Growth and Patterns of Spread
Diagnosis and Management
Tips and Tricks of Cutaneous Melanoma US Examination
Technological Requirements
Primary Tumor Examination
Locoregional Examination
Primary Cutaneous Melanoma: US Findings
Role of US in Primary Cutaneous Melanoma
Differential Diagnosis
Measuring Tumor Thickness
Prognosis
Cutaneous Melanoma Staging
The Sentinel Lymph Node Biopsy
Conceptual Aspects
Description of the Procedure
Post-SLNB Patient Management
US and the SLNB
Satellite, In-Transit, and Lymph Node Melanoma Metastasis: US Findings
US Imaging of Satellite/In-Transit Metastasis
US Imaging of Lymph Node Metastasis
Cutaneous Melanoma Follow-Up
US Guidance for Diagnostic and Therapeutic Procedures
Response to Treatment
US of Cutaneous Melanoma: Challenging Aspects and Essential Requirements
Conclusions and Future Perspectives
References
11: Ultrasound of Cutaneous Lymphomas
Conclusion
References
12: Use of Ultrasound in Cryosurgical Treatment
Introduction
The Need for a Variety of Therapeutic Approaches and the Role of HFUS
Cryotherapy as a Treatment Option for Keratinocyte Carcinomas
Trans-Cryosurgical Control with HFUS
Cryobiopsy and Ex Vivo HFUS
Contraindications
Conclusions
References
13: Basal Cell Carcinoma Ultrasound Examination with 20 and 75 MHz High-Frequency Ultrasound
Introduction
Literature Review
Clinical Cases
Case 1
Clinical Case 2
Clinical Case 3
Case 4
Case 5
Case 6
Conclusion
References
14: Role of Ultrasound at 50 MHz in Skin Cancer
Basal Cell Carcinoma
Squamous Cell Carcinoma
Malignant Melanoma
Primary Cutaneous Lymphoma
References
15: Role of Ultrasound at 70 MHz in Skin Cancer
Introduction
Melanoma
Non-melanoma Skin Cancers
Cutaneous Lymphomas
Dermatofibrosarcoma Protuberans (DFSP)
Nevus Sebaceous of Jadassohn
Conclusion
References
16: Ultrasound of Vascular Tumors
Introduction
Benign Tumors
Hemangiomas
Infantile Hemangiomas
Congenital Hemangiomas
Angiokeratoma-Verrucous Hemangioma
Glomus Tumor-Glomangioma-Glomuvenous Malformation
Glomus Tumor
Glomangiomas
Glomuvenous Malformations
Pyogenic Granuloma
Angiolymphoid Hyperplasia with Eosinophilia
Kaposiform Hemangioendothelioma
Malignant
Angiosarcoma
Kaposi’s Sarcoma
Conclusion
References
17: Main Concepts on Ultrasonography of Dermatologic Inflammatory Conditions
Introduction
Considerations on the Ultrasound Examination Protocol of Inflammatory Conditions
Cutaneous Inflammatory Conditions
Edema and Lymphedema
Seromas, Hematomas, and Serohematomas
Abscesses and Fistulous Tracts
Odontogenic Fistula
Panniculitis
Morphea
Cutaneous Lupus
Dermatomyositis
Psoriasis
Acne
Rosacea
Hidradenitis Suppurativa (HS)
Foreign Bodies
References
18: Clinical Overview of Inflammatory Dermatologic Conditions
Introduction
Cutaneous Lupus Erythematosus
Morphea
Dermatomyositis
Raynaud’s Phenomenon
Vasculitis of the Skin
Cutaneous Involvement in Inflammatory Bowel Diseases
References
19: Clinical Overview of Psoriasis and Psoriatic Arthritis
Epidemiology
Etiopathogenesis
Histopathology
Clinical Manifestations
Clinical Variants
Treatment
References
20: Ultrasound of Common Infestations and Infections
Introduction
Myiasis
Larva Migrans
Cutaneous Tuberculosis
Leishmaniasis
Leprosy
Mycetomas
Hyalohyphomycosis
Phaeohyphomycosis
Warts
References
21: Ultrasound of Nail Conditions
Introduction
Benign Pathology
Tumors and Pseudotumors
Ungual
Solid
Glomus Tumor
Onychomatricoma
Fibroma
Neurogenic Tumors: Schwannoma and Perineurioma
Keratoacanthoma
Granuloma
Cystic
Mucous Cysts
Periungual
Solid
Periungual Fibroma: Acquired Ungual Fibrokeratoma
Exostosis
Periungual Granuloma
Cystic
Myxoid or Synovial Cyst
Inflammatory Conditions
Psoriasis
Lupus
Rheumatoid Arthritis
Dermatomyositis
Scleroderma
Fluid Collections
Median Canaliform Dystrophy
Subungual Wart
Growth Alterations
Congenital
Malalignment
Cystic Fibrosis
Acquired
Onychocryptosis
Onychomadesis
Retronychia
Malignant Pathology
Squamous Cell Carcinoma
Melanoma
References
22: Ultrasound in Aesthetics
Introduction
Cosmetic Fillers
Detection and Identification of Cosmetic Fillers
Anechoic
Hyaluronic Acid
Polyacrylamide Gel (PAAG)
Pure Silicone
Hypoechoic or Heterogeneous
Polycaprolactone
Hyperechoic
Silicone Oil
Polymethylmethacrylate (PMMA)
Calcium Hydroxyapatite (CaOH)
Assessment of the Location and Extent of Cosmetic Fillers
Complications of Cosmetic Fillers
Early Complications
Immediate Complications
Intermediate Complications
Management of Early Complications
Late Complications
Chronic Inflammation
Granulomatous Reaction
Sarcoid Reaction
Panniculitis
Morphea and Morphea-Like Reactions
Lumps and Bumps
Inflammation of the Lacrimal, Parotid, and Submandibular Glands
Nonsurgical Aesthetic Procedures
Mesotherapy
Cryolipolysis
Radiofrequency
Autologous Fat Grafting
Tensor Threads
Implants
Surgical Aesthetic Procedures
Liposuction
Abdominoplasty
Blepharoplasty
Rhinoplasty
References
23: Cutaneous Ultrasonography in Pediatric Dermatology
Introduction
Generalities
Environment, Distraction, and Sedation
Nonvascular Tumors and Hamartomas
Nonvascular Tumors
Benign Tumors
Neurofibroma
Lipoblastoma
Pilomatricoma
Syringocystadenoma Papilliferum
Fibrous Hamartoma of Infancy (FHI)
Infantile Myofibroma
Superficial Angiomyxoma
Juvenile Xanthogranuloma
Malignant Tumors
Metastatic Neuroblastoma
Plexiform Fibrohistiocytic Tumor
Infantile Fibrosarcoma
B-Cell Lymphoblastic Lymphoma (BcLL)
Hamartomas
Nevus Sebaceous of Jadassohn
Cutaneous Smooth Muscle Hamartoma (CSMH)/Becker’s Nevus
Cutaneous Fibrolipomatous Hamartoma
Inflammatory Lesions
Subcutaneous Fat Necrosis of the Newborn (SCFN)
Idiopathic Facial Aseptic Granuloma (IFAG)
Subcutaneous Granuloma Annulare
Linear Morphea
Segmental Stiff Skin Syndrome
Vascular Lesions
Tumors
Lobular Capillary Hemangioma (Pyogenic or Telangiectatic Granuloma)
Infantile Hemangioma (IH)
Congenital Hemangioma (CH)
Tufted Angioma (TA) and Kaposiform Hemangioendothelioma (KHE)
Vascular Malformations
Fast Flow (High Flow)
Arteriovenous Malformation (AVM)
Low Flow
Capillary Malformations (CM)
Venous Malformation (VM)
Lymphatic Malformations (LM)
Other Embryological Developmental Anomalies
Aplasia Cutis Congenita (ACC)
Sinus Pericranii (SP)
Cephalocele and Atretic Cephalocele
Cysts, Sinuses, and Fistulae
Dermoid Cyst (DC)
Preauricular Sinus/Fistula (PS)
Branchial Cleft Anomalies
Thyroglossal Duct Cyst (TGDC)
Midline Anterior Neck Inclusion Cyst (MANIC)
Bronchogenic Cyst
Congenital Sternoclavicular Sinus
Spinal Dermal Sinus Tract (DST)
Spinal Pseudo-Dermal Sinus Tract (PDST) or Spinal Dermal Sinus-Like Stalk
Miscellanea
Foreign Bodies
Hair-Thread Tourniquet Syndrome
Delayed Granulomatous Reaction Induced by Retained Electrodes from a Cardiac Pacemaker
Iatrogenic Calcinosis Cutis
Hematomas
Soft-Tissue Hematomas
Neonatal Scalp Hematoma
Caput Succedaneum
Cephalohematoma
Subgaleal Hematoma
References
Part III: Practicalities
24: Tips for Reporting Dermatologic Ultrasound Examinations
Introduction
Relevant Information in the Report
Examples of Reports
Reporting an Epidermal Cyst
History
Technique
Report
Ultrasonographic Impression
Reporting a Pilomatrixoma
History
Technique
Report
Ultrasonographic Impression
History
History
Technique
Report
Ultrasonographic Impression
Reporting a Plantar Wart
History
Technique
Report
Ultrasonographic Impression
Reporting an Infantile Hemangioma
History
Technique
Report
Ultrasonographic Impression
Reporting a Vascular Malformation
History
Technique
Report
Ultrasonographic Impression
Reporting a Morphea
History
Technique
Report
Ultrasonographic Impression
Reporting a Hidradenitis Suppurativa
History
Technique
Report
Ultrasonographic Impression
Reporting a Nail Psoriasis
History
Technique
Report
Ultrasonographic Impression
Reporting Cosmetic Fillers
History
Technique
Report
Ultrasonographic Impression
Reporting a Basal Cell Carcinoma
History
Technique
Report
Ultrasonographic Impression
Reporting a Melanoma
History
Technique
Report
Ultrasonographic Impression
References
25: Ultrasound Intervention in Tumors, Pseudotumors, and Vascular Soft-Tissue Lesions
Ultrasound as a Technique to Guide Procedures
Biopsy
Technique
Outcome
Percutaneous Treatment of Fluid-Filled Lesions
Ganglion Cysts
Treatment
Outcome
Bursitis
Treatment
Outcome
Percutaneous Treatment of Dupuytren’s Disease
US-Guided Percutaneous Needle Fasciotomy
Outcome
Percutaneous Treatment of Arteriovenous Malformations
Percutaneous Sclerotherapy
Percutaneous Intervention on Cosmetic Fillers
Complications of Cosmetic Fillers and Treatment
Allergic Reactions
Displacement of the Fillers
Foreign Bodies’ Removal
Ultrasound-Guided Removal of Foreign Bodies
References
26: Ultrasound-Assisted Hidradenitis Suppurativa Procedures
Introduction
Intralesional Drug Infiltrations
Delimitation of the Extent of the Surgical Area with Ultrasound in HS
References
27: Interventional Dermatologic Ultrasound in Aesthetics
Interventional Dermatologic Ultrasound: Aesthetics
References
28: The Role of Ultrasound in the Use of Hyaluronidase
Introduction
Recognition of Hyaluronic Acid by Ultrasound Imaging
Ultrasound-Guided Injections to Resolve Complications in Hyaluronic Acid Fillers
Prevention of Complications: Pre-Treatment Assessment
Other Filler Complications
References
Appendix: Self Assessment Modules (CME Questions)
CME Questions: Technical Recommendations (Ximena Wortsman, Fernando Alfageme)
CME Questions: Dermatologic Concepts and Terminology (Diana Crisan, Maria Crisan)
CME Questions: Ultrasound Maging: Basic Concepts and Terminology (Diana Gaitini)
CME Questions: Normal Anatomy (Ximena Wortsman)
CME Questions: Relevant Topographic Anatomy of the Head, Anatomical Variants, and Risk Zones (Ximena Wortsman)
CME Questions: Congenital (Ximena Wortsman)
CME Questions: Benign Nonvascular Tumors (Ximena Wortsman)
CME Questions: Skin Cancer (Ximena Wortsman)
CME Questions: Vascular Tumors (Ximena Wortsman)
CME Questions: Inflammatory (Ximena Wortsman)
CME Questions: Infestations and Infections (Ximena Wortsman)
CME Questions: Ultrasound of Nail Conditions (Ximena Wortsman)
CME Questions: Aesthetics (Ximena Wortsman)
CME Questions: Pediatric Dermatology (Ximena Wortsman)
CME Questions: Interventional (Jose Luis del Cura, Gorka del Cura, Ximena Wortsman)
Index