Sarcoidosis of The Breasts - When Should It Be Considered? a Case Report.

Sarcoidosis is a systemic inflammatory disease of unknown aetiology. Given its complex clinical presentation, the disorder frequently causes diagnostic challenges. In most cases, the primary manifestation is in the lungs and mediastinum. Breast involvement as the primary manifestation of sarcoidosis is rare, accounting for less than 1% of cases. The authors present the case of a 44-year-old woman whose disease first manifested as multiple non-specific BIRADS 4 lesions in both breasts, accompanied by axillary lymphadenopathy, detected by ultrasound examination. The lesions were not visible on mammography. The course of the disease was clinically silent, with intermittent remissions, until the complete resolution of focal breast lesions on ultrasound after two years of follow-up. The paper presents an algorithm for the management of multifocal breast pathology with associated lymphadenopathy, which led to the prompt verification of sarcoidosis.

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

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.

S-Detect Software vs. EU-TIRADS Classification: A Dual-Center Validation of Diagnostic Performance in Differentiation of Thyroid Nodules.

Computer-aided diagnosis (CAD) and other risk stratification systems may improve ultrasound image interpretation. This prospective study aimed to compare the diagnostic performance of CAD and the European Thyroid Imaging Reporting and Data System (EU-TIRADS) classification applied by physicians with S-Detect 2 software CAD based on Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and combinations of both methods (MODELs 1 to 5). In all, 133 nodules from 88 patients referred to thyroidectomy with available histopathology or with unambiguous results of cytology were included. The S-Detect system, EU-TIRADS, and mixed MODELs 1-5 for the diagnosis of thyroid cancer showed a sensitivity of 89.4%, 90.9%, 84.9%, 95.5%, 93.9%, 78.9% and 93.9%; a specificity of 80.6%, 61.2%, 88.1%, 53.7%, 73.1%, 89.6% and 80.6%; a positive predictive value of 81.9%, 69.8%, 87.5%, 67%, 77.5%, 88.1% and 82.7%; a negative predictive value of 88.5%, 87.2%, 85.5%, 92.3%, 92.5%, 81.1% and 93.1%; and an accuracy of 85%, 75.9%, 86.5%, 74.4%, 83.5%, 84.2%, and 87.2%, respectively. Comparison showed superiority of the similar MODELs 1 and 5 over other mixed models as well as EU-TIRADS and S-Detect used alone (p-value < 0.05). S-Detect software is characterized with high sensitivity and good specificity, whereas EU-TIRADS has high sensitivity, but rather low specificity. The best diagnostic performance in malignant thyroid nodule (TN) risk stratification was obtained for the combined model of S-Detect ("possibly malignant" nodule) and simultaneously obtaining 4 or 5 points (MODEL 1) or exactly 5 points (MODEL 5) on the EU-TIRADS scale.

Lipoma removal using a high-frequency ultrasound-guided injection of a Class III CE-marked device-Empirical findings.

BACKGROUND: Lipomas are very common benign neoplasms, which constitute 99% of all adipose-derived tumors. Main treatment option includes surgical excision, which is unacceptable for a number of patients seeking ways to improve esthetic appearance of their skin. Therefore, alternative treatment options are being sought. OBJECTIVE: The aim of the present study was to assess the efficacy of lipoma removal using a Class III CE-marked device (Aqualyx™) administered as a high-frequency ultrasound-guided injection (intralipotherapy). METHODS: A total of 17 lipomas were treated. The procedure involved a high-frequency ultrasound-guided injection. A maximum of 3 injections per a lipoma were performed. High-frequency ultrasound was used for assessing the size of lipomas and monitoring treatment-induced changes to the lipomas and adjacent tissue. RESULTS: Response to treatment was achieved in all cases. A complete removal was achieved in 70.59% of lipomas. The remaining 29.41% of lipomas were not completely removed, yet significantly reduced in size. CONCLUSION: An injection of Aqualyx™, a CE-marked drug, is a good noninvasive treatment of lipomas. Ultrasound guided procedure is recommended, as it ensures appropriate technique and enables monitoring treatment-induced changes. Considering a low number of published reports of such treatment, it is crucial to continue this research.

Assessment of the efficacy and safety of steam vein sclerosis as compared to classic surgery in lower extremity varicose vein management.

INTRODUCTION: For the last 10 years, endovenous thermal ablation methods have gradually predominated over the classic Babcock procedure in varicose vein treatment. Steam vein sclerosis is the newest thermal ablation technique. AIM: To assess the efficacy and safety of steam vein sclerosis as compared to the Babcock procedure in lower extremity varicose vein treatment. MATERIAL AND METHODS: One hundred and two adult subjects with varicose veins of clinical grade C2 to C6 according to the CEAP classification, treated with varicose vein surgery between 2010 and 2012, were enrolled in the study. These were subdivided into two groups: the study group of 52 patients treated with endovenous steam vein sclerosis and the control group of 50 patients treated with the Babcock procedure. A single lower extremity with isolated great or small saphenous vein insufficiency was operated on in each subject. The groups were compared for demography, disease severity, involved veins, potential perioperative and postoperative complications, as well as treatment efficacy based on the VCSS score reduction. RESULTS: There were no statistically significant differences between the groups in terms of demography, disease severity, involved veins, or perioperative and postoperative complications. The treatment efficacy of both methods, assessed based on the recurrence rate and the quantitative VCSS score reduction, was similar. Clinically significant recanalisation was observed in 1 (1.9%) patient in the study group. CONCLUSIONS: The efficacy and safety analysis shows that steam vein sclerosis is a safe, simple method which can be recommended as effective varicose vein treatment.

The use of high frequency ultrasound imaging in skin moisturization measurement.

INTRODUCTION: The appropriate skin hydration level enables its normal function and healthy appearance. PURPOSE: The purpose of present research was to assess the applicability of high frequency ultrasound (HFU) to the monitoring of skin moisturization treatments. MATERIAL AND METHODS: The study sample encompassed 27 women, aged 20-67 y.o. (mean age of 45.48 y.o.) with dry skin. All women applied a strong moisturizing cream on their facial skin for 14 days. The course of treatment was monitored using the HFU. The following parameters were subjected to the ultrasound evaluation: epidermal echo thickness, dermis thickness, and separately the thickness of the superior and inferior layer of dermis. The measurements were taken on the participants' chins and cheeks. In addition, skin hydration and transepidermal water loss (TEWL) were determined. RESULTS: Statistically significant differences were obtained between the echogenicity of the superior layer of the dermis on the chin and cheek. After treatment, the statistically significant values of TEWL decrease and hydration increase were obtained on the cheek skin. No statistically significant differences between the TEWL or hydration levels were found on the chin. No statistically significant differences between the epidermal echo and dermis thickness values for the two measurement points were observed. CONCLUSION: The HFU is a useful method for the monitoring of skin moisturization treatments.