Ultrasonography of Skin Changes in Legs with Chronic Venous Disease

Caggiati, Alberto

doi:10.1016/j.ejvs.2016.03.022

Cited by 34 publications

(27 citation statements)

References 26 publications

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“…In edematous legs, the subcutaneous layer was found to be particularly thickened with a hypo-echoic pattern (Figure 2B). This finding is supported by a previous ultrasound study of the skin of C3 class leg edema that used the clinical etiology anatomy pathophysiology (CEAP) classification of venous disease, which also showed thickening of the subcutaneous layer [11].…”

Section: Discussionsupporting

confidence: 71%

“…Previously published studies on the measurement of the thickness of the skin of the leg using ultrasonography have been reported in patients with chronic venous disease [11], lymphedema [12,13], synovitis with pitting edema syndrome (RS3PE) [14], and age-related diurnal changes of dermal edema [15]. Most of these previous studies have shown varied ultrasound patterns of subcutaneous edema.…”

Section: Discussionmentioning

confidence: 99%

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A Quantitative Method to Measure Skin Thickness in Leg Edema in Pregnant Women Using B-Scan Portable Ultrasonography: A Comparison Between Obese and Non-Obese Women

et al. 2019

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BackgroundThis study aimed to use a portable ultrasound method to quantitatively measure skin thickness and to compare leg edema in obese and non-obese pregnant women.Material/MethodsThirty-six pregnant women (17 primiparas and 19 multiparas) at 27/28 and 37/38 weeks of pregnancy, with and without leg edema, had their lower leg skin thickness measured using a B-scan portable ultrasonography device (72 legs and maximum of 98 measurements). Measurements were compared between women who were obese prior to pregnancy, with a body mass index (BMI) ≥25 kg/m2 and non-obese with a BMI <25 kg/m2.ResultsSkin thickness of the legs in pregnant women with edema was significantly increased compared with that in pregnant women without edema (6.4±0.3 mm vs. 4.6±0.4 mm) (p=0.0001). There was a significant correlation between the degree of pitting edema and skin thickness in all edematous legs (ρ=0.56; n=98; p<0.0001). The cutoff level of edema measured by portable ultrasound in non-obese pregnant women was 4.7 mm (sensitivity 83.9%, specificity 66.7%) and was 7.5 mm in obese pregnant women. Obese pregnant women with edema had a significantly increased leg skin thickness compared with non-obese pregnant women with edema (11.3±1.3 mm vs. 5.7±0.2 mm) (p<0.0001).ConclusionsPortable ultrasonography is a reliable method of quantitatively measuring skin thickness of the lower leg in edema associated with pregnancy. The thickness of the skin in obese pregnant women with edema can be expected to be significantly increased compared with non-obese pregnant women with edema.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

A Quantitative Method to Measure Skin Thickness in Leg Edema in Pregnant Women Using B-Scan Portable Ultrasonography: A Comparison Between Obese and Non-Obese Women

et al. 2019

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“…The use of ultrasound technique as a characterization tool is not new. Its use has progressively increased in the field of dermatology over the past decade, providing information in the clinical examination of a wide range of diseases, with inflammatory skin diseases among them . In HS, ultrasound can map skin lesions, and its use helps identify the extent of the lesions more precisely than routine physical examination, as well as the inflammatory activity of these lesions with the use of colour Doppler.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound as a diagnostic and management tool in hidradenitis suppurativa patients: a multicentre study

Martorell

Alfageme

Rull

et al. 2019

Acad Dermatol Venereol

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Background It has been reported that clinical evaluation consistently underestimates the severity of hidradenitis suppurativa (HS). Objective To determine the usefulness of ultrasound as a diagnostic tool in HS compared with clinical examination and to assess the subsequent modification of disease management. Methods Cross‐sectional multicentre study. Severity classification and therapeutic approach according to clinical vs. ultrasound examination were compared. Results Of 143 HS patients were included. Clinical examination scored 38, 70 and 35 patients as Hurley stage I, II and III, respectively; with ultrasound examination, 21, 80 and 42 patients were staged with Hurley stage I, II and III disease, respectively (P < 0.01). In patients with stage I classification as determined by clinical examination, 44.7% changed to a more severe stage. Clinical examination indicated that 44.1%, 54.5% and 1.4% of patients would maintain, increase or decrease treatment, respectively. For ultrasound examination, these percentages were 31.5%, 67.1% and 1.4% (P < 0.01). Concordance between clinical and ultrasound intra‐rater examination was 22.8% (P < 0.01); intra‐rater and inter‐rater (radiologist) ultrasound agreement was 94.9% and 81.7%, respectively (P < 0.01). Limitations The inability to detect lesions that measure ≤0.1 mm or with only epidermal location. Conclusion Ultrasound can modify the clinical staging and therapeutic management in HS by detecting subclinical disease.

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“…There was broad disagreement on statement 3, indicating that the vast majority of specialists feel that C2 patients do not have the same clinical characteristics. In this regard, it should be kept in mind that CEAP classification is not a classification of severity, and the C2 subcategory comprises all types of varicose veins [40]. In fact, among C2 patients, there is a variety of risk factors and age, accounting for some variability [41].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, ultrastructural morphology of venous valves in chronic venous disorders may not depend on age in patients with C2 disease [41]. It has also been demonstrated that there is a high degree of histological variability in patients with C2 disease with marked inflammation in some patients, which may help explain the different severity of symptoms among patients even with the same stage of disease [40,41]. Taken together, these considerations confirm that C2 is a subgroup that encompasses a wide variety of clinical characteristics and symptoms.…”

Section: Discussionmentioning

confidence: 99%

Refining diagnosis and management of chronic venous disease: Outcomes of a modified Delphi consensus process

Aloi

Camporese

Izzo

et al. 2019

European Journal of Internal Medicine

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Chronic venous disease (CVD) is a common condition with major health consequences that is associated with poor long-term prognosis, significant socioeconomic impact, disabling symptoms and reduced quality of life. To provide practical guidance for diagnosis and management of CVD, a Delphi panel of 5 experts in steering committee and 28 angiologists/vascular surgeons met with the major aim of providing a supplement for established national and international guidelines. A total of 24 statements were voted upon in two rounds, of which consensus was reached on 22 statements, indicating a high level of overall agreement. Consensus was reached on 7 of 8 statements relative to diagnosis (CEAP classification, diagnostic tools, QoL assessment, diagnostic imaging) and on 15 of 16 statements on management (conservative treatments, compressive therapy, pharmacological therapy, surgical treatment). The results of the consensus reached are discussed herein from which it is clear that diagnostic and management approaches utilising personalised therapies tailored to the individual patient should be favoured. While it is clear that additional studies are needed on many aspects of diagnosis and management of CVD, the present Delphi survey provides some key recommendations for clinicians treating CVD that may be useful in daily practice.

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Ultrasonography of Skin Changes in Legs with Chronic Venous Disease

Cited by 34 publications

References 26 publications

A Quantitative Method to Measure Skin Thickness in Leg Edema in Pregnant Women Using B-Scan Portable Ultrasonography: A Comparison Between Obese and Non-Obese Women

A Quantitative Method to Measure Skin Thickness in Leg Edema in Pregnant Women Using B-Scan Portable Ultrasonography: A Comparison Between Obese and Non-Obese Women

Ultrasound as a diagnostic and management tool in hidradenitis suppurativa patients: a multicentre study

Refining diagnosis and management of chronic venous disease: Outcomes of a modified Delphi consensus process

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