Sonographic analysis of the ankle in patients with psoriatic arthritis.

Foot involvement is very frequent in patients affected by psoriatic arthritis (PsA). However, evaluation of the painful foot can be problematic, because it is often difficult to distinguish between arthritis, tenosynovitis, and enthesopathy. Plain radiographs can show bone erosion or other features of joint involvement, but give little information about the soft tissues. We therefore studied foot involvement in 31 PsA patients using high resolution sonography, and compared the results with the findings on x-ray and clinical examination. Ultrasound revealed pathological findings in a large proportion of the patients, most of whom exhibited no clinical (pain or swelling) or radiological signs of foot involvement at the time of the study. Our data suggest that involvement of the tendons and entheses may be more frequent in PsA patients than has thus far been supposed, even in cases of not particularly aggressive disease, and that clinical evaluation tends to underestimate these manifestations.

[Hematoma and fat necrosis of the breast: mammographic and echographic features]. / Ematoma e liponecrosi mammaria. Quadri mammografici ed ecografici.

The mammary gland is a common site for traumas which often lead to the formation of intraglandular hematomas. The abundance of fat tissue in this gland accounts for the relatively high frequency of fat necrosis and self-digestion of fat by lipases after traumas, i.e., fat necrosis, cystosteatonecrosis, lipophagic granuloma. Broadly speaking, hematomas are easily diagnosed by both mammography and US. However, scarring and the formation of lipophagic granulomas due to hemorrhage result in the diagnostic features which are difficult to distinguish from malignant breast nodules. In our study, we examined 40 patients with a clinically detected nodule and/or hematoma with skin retraction or thickening related to trauma. In 26 women, the trauma dated to 7-60 days before our observation, in 4 women to a year before and in 4 other women to more than two years before; 6 women had undergone breast surgery in the last two years. Mammography and US were performed at first observation; later, every six months, the patients were followed-up with US and a single targeted radiograph. The mammographic features at first observation were classified as follows: a single nodule (9 patients, 22.5%), a patchy nodule (7 patients, 17.5%), diffusely increased gland density (8 patients, 20%), radiolucent nodules (10 patients, 25%), nodules with calcifications (6 patients, 15%), no findings (2 patients, 5%). US demonstrated a fluid collection in 12 patients (30%), a solid nodule in 6 patients (15%), a cystic nodule in 10 patients (25%), diffuse parenchymal abnormalities in 4 patients (10%), calcified nodules in 6 patients (15%) and no findings in 2 patients (5%). US-guided needle biopsy was performed in 10 patients. Five patients underwent surgical biopsy: 4 had a lipophagic granuloma and the other one a chronic inflammation. Follow-up at two years allowed hematoma evolution to a scar or cystosteatonecrosis to be monitored. To conclude, the authors analyze the diagnostic problems related to the different mammographic and US patterns trying to suggest, on the basis of their own experience, the best imaging follow-up for breast trauma patients.

[Echography in the study of lipomas of superficial soft tissues]. / L'ecografia nello studio dei lipomi dei tessuti molli superficiali.

High-resolution sonography (US) was used to evaluate 47 superficial soft tissue lipomas. Forty-one lesions were found in subcutaneous tissues and 6 in superficial muscles. The lipomas were classified by location, shape, echotexture, homogeneity and US beam attenuation values. Moreover, 21 lipomas underwent histology and histologic patterns were correlated with echogenicity. Most lesions were elongated and their greatest diameter was parallel to the skin. Eighty-four percent exhibited well-defined margins. Twenty-six percent of the lipomas were hypoechoic, 24% were isoechoic, 34% hyperechoic and 16% exhibited a mixed pattern. In 27% of cases, a hypoechoic capsule was present. Superficial soft tissue lipomas exhibit unsteady echotexture: most of them are hyperechoic. The correlation between echotexture and histology showed that no typical and steady patterns can be identified, since lipomas vary from a histologic point of view. The clinical diagnosis of superficial lipomas is based on clinical history and the palpation of a well-defined, mobile and soft superficial mass. When palpation is not diagnostic, US can be used to rule out a cyst. An elongated isoechoic or hyperechoic mass in the subcutaneous tissue should suggest a lipoma, whereas a hypoechoic mass is associated with a broader range of differential diagnoses, including malignant tumors. However, malignant masses are not likely to have an elongated or flattened shape. Even though tissue characterization is less specific with US than with CT and MRI, the former method is quick, easy and less expensive and, thanks to high-frequency transducers, is also well-suited to diagnose soft tissue lipomas.

[Echography for the diagnosis of aneurysmal bone cysts]. / L'ecografia nella diagnosi di cisti ossea aneurismatica.

Aneurysmal bone cysts are benign tumors which are likely to recur. While growing, they cause severe osteolysis, able to balloon the bone and to thin the cortex. The latter is reduced to a thin bone shell, and sometimes completely interrupted. Tumor mass can spread into the surrounding soft tissues as in other bone tumors, especially malignant ones, which are often misdiagnosed. Whether the cortex is interrupted or only thinned, an acoustic window is obtained which allows an easy study of tumor mass with US. Seven patients were examined, who presented lytic lesions of different bones, produced by aneurysmal cysts. US allowed the expansile lesion to be detected, and its size to be estimated. Moreover, US pattern of the lesion could be determined, which appeared both solid and liquid. A few minutes after beginning the examination, fluid levels could be observed to appear, which are typical of this condition, as both CT and MR imaging demonstrate both in vivo and in vitro. Thus US, thanks to its short execution time, low cost and non-invasiveness, can be considered as the second-step exam, after plain film, in the diagnosis of aneurysmal bone cyst.

[Bone within bone of the vertebral body]. / "L'osso nell'osso" del corpo vertebrale.

The finding of a small vertebral body inside one or more vertebral bodies is not commonly observed even if it is present in many conditions, but it lacks both a systemic description and an interpretative evaluation. After examining different radiological aspects we tried to find out their meaning which is explained by three different possible patterns: a physiological pattern in the newborn; a dystrophic pattern due to failure in prowing; and last a strengthening and support for the reduced resistance of the bone.