Usefulness of ultrasonography in the diagnosis of subcutaneous granuloma annulare

Vázquez‐Osorio, Igor; Quevedo, A. Diaz De La Rocha; Rodríguez-Vidal, Adriana; Rodríguez‐Díaz, Eloy

doi:10.1111/pde.13470

Cited by 17 publications

(6 citation statements)

References 7 publications

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“…On the US images of most of our SGA patients, we have detected the same cap-shaped presentation located on the muscle's fascia compatible with the sign as it is seen on the MRI images of these patients. US findings were otherwise described as solid nodules with ill-defined borders and noted central hypoechoic zone surrounded by a hyperechogenic periphery, agreeing with the sonographic characteristics of SGA reported in a few previously published studies ( 11 , 12 , 15 , 17 , 24 – 26 ). MRI is often performed because it is one of the most specific imaging modalities to noninvasively clarify lesions whose entities have remained unclear.…”

Section: Discussionsupporting

confidence: 90%

“…The initial clinical impression about the sudden appearance of an unclear subcutaneous lump in a child can be either dubious or misleading, thus, making this disease notoriously difficult to diagnose ( 11 – 13 ). Although various imaging features of SGA lesions have been described in the literature, no specific hallmark is yet recognized to help clinicians distinguish SGA from other differential diagnostic considerations ( 9 , 12 – 17 ). As a result, children often undergo several unavailing investigations before a biopsy is performed to rule out malignancy and establish an adequate SGA diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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The epifascial cap: A typical imaging sign for subcutaneous granuloma annulare in children

et al. 2023

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ObjectivesSubcutaneous granuloma annulare (SGA) is a rare, self-limiting granulomatous disease in children, commonly diagnosed by histopathology following biopsy or surgical excision. This study aimed to identify imaging clues for SGA that could expedite accurate diagnosis and avoid the need for biopsy in children.MethodsWe retrospectively analyzed complete hospital records of all children diagnosed with SGA at our institution from January 2001 to December 2020. Detailed disease history, imaging findings, management, and outcome were evaluated.ResultsWe identified 28 patients (20 girls) at a median age of 3.75 (range 1–12.5 years). Ten patients presented with multiple lesions. Most lesions were located on the lower extremities (n = 26/41). Ultrasound examinations were performed on all patients, and 12 (43%) patients also received an MRI. Surgical intervention was conducted in 18 (64%) patients either by incisional biopsy (n = 6) or total excision of the lump (n = 12). In all patients who did not undergo surgery, SGA resolved spontaneously. A careful review of the MRIs led to the discovery of a characteristic imaging shape of SGA lesions: the epifascial cap with a typical broad circular base laying on the fascia, extending towards the subdermal/dermal tissue. This distinctive shape was evident in every patient in our cohort.ConclusionsThe “Epifascial Cap Sign” is a specific imaging sign for SGA, which to the best of our knowledge, helps distinguish this disease from other subcutaneous lesions. Recognition of this novel diagnostic sign combined with the historical and physical findings should enable clinicians to establish SGA diagnosis easily and diminish the need for further invasive diagnostic procedures.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

The epifascial cap: A typical imaging sign for subcutaneous granuloma annulare in children

et al. 2023

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“…Unfocused vessels of variable appearance against a pinkish-reddish background are characteristic but by no means pathognomonic [ 31 , 32 ]. Recently, ultrasound was reported to be of utility in the diagnosis of subcutaneous GA [ 33 , 34 ]. As subcutaneous GA is more common among children (who may be more averse to biopsy), ultrasound may represent a novel and useful tool in the diagnosis of this rare GA variant, although further studies are needed to validate the efficacy of ultrasound.…”

Section: Clinical and Histological Presentation And Differential Diagnosismentioning

confidence: 99%

Granuloma Annulare: An Updated Review of Epidemiology, Pathogenesis, and Treatment Options

Joshi

Duvic

2021

Am J Clin Dermatol

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Granuloma annulare (GA) is an inflammatory granulomatous skin disease that can be localized (localized GA) or disseminated (generalized GA), with patch, perforating, and subcutaneous subtypes being less common variants of this benign condition. Recently, new research has emerged that further elucidates GA epidemiology and etiopathogenesis; importantly, new therapeutic options for GA have also been described, although there remains a paucity of randomized controlled studies. In this review, we summarize recent updates on GA epidemiology and etiopathogenesis and offer an updated review of the therapeutic options for GA currently reported in the literature. We hope that the current review galvanizes randomized controlled studies that will in turn help lead to the recommendation of evidence-based treatments for GA.

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“…It manifests as painless, immobile, skin‐colored, or brown subcutaneous nodules, commonly located on the anterior shins. Sonographically, it appears as an ill‐defined hypoechoic avascular lesion located in the hypodermis, in contact with the fascia . Increased echogenicity in the surrounding tissues is usually noted.…”

Section: Ultrasonographic Findings Of Inflammatory Dermatosesmentioning

confidence: 99%

“…Sonographically, it appears as an ill-defined hypoechoic avascular lesion located in the hypodermis, in contact with the fascia. 77 Increased echogenicity in the surrounding tissues is usually noted. Highly hyperechoic dots within the lesion, corresponding to calcifications, have also been described (Figure 11).…”

Section: Ultr a Sonog R Aphic Finding S Of Infl Ammatory Dermatos E Smentioning

confidence: 99%

Cutaneous ultrasound and its utility in pediatric dermatology. Part I: Lumps, bumps, and inflammatory conditions

Bandera

Sebaratnam

Feito-Rodríguez

et al. 2019

Pediatric Dermatology

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High-frequency ultrasonography represents a promising tool for pediatric dermatologists. It is a non-invasive diagnostic technique that is particularly appealing when working with children. It can be easily performed at the patient's bedside, avoiding diagnostic delays, sedation, or multiple visits. It represents a useful adjunct to clinical examination and can enhance our understanding of cutaneous diseases. Patient cooperation and limited training and experience are the main challenges for cutaneous ultrasonography in pediatric dermatology. This review describes cutaneous ultrasonography and the nuances of its use in the pediatric setting, followed by the ultrasonographic findings of cutaneous lumps, bumps, and inflammatory dermatoses commonly encountered in pediatric patients. K E Y W O R D Scyst, morphea, neurofibroma, pilomatricoma, ultrasound 30 |

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Usefulness of ultrasonography in the diagnosis of subcutaneous granuloma annulare

Cited by 17 publications

References 7 publications

The epifascial cap: A typical imaging sign for subcutaneous granuloma annulare in children

The epifascial cap: A typical imaging sign for subcutaneous granuloma annulare in children

Granuloma Annulare: An Updated Review of Epidemiology, Pathogenesis, and Treatment Options

Cutaneous ultrasound and its utility in pediatric dermatology. Part I: Lumps, bumps, and inflammatory conditions

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