Abstract
Purpose
Diagnosis of granuloma annulare (GA) is based on the clinical and histopathological findings. However, only sporadic case reports of subcutaneous GA sonography have been published to date. The objective of this study was to evaluate the ultrasonographic patterns of the different clinical variants of GA: localized, generalized, subcutaneous, and perforating.
Methods
In this retrospective observational study, we analyzed and correlated the clinical, histopathological, and sonographic features of 15 patients diagnosed with GA.
Results
We included 8 women and 7 men with a mean age of 48.4 years (8–77 years). We found three different sonographic patterns depending on the clinical variant of GA: poorly defined hypoechoic band including the dermis (dermal pattern), irregularly shaped hypoechoic hypodermal lumps (hypodermal pattern), and ill-defined hypoechoic dermal and subcutaneous lesions (mixed pattern). Five cases showed increased blood flow signal on Doppler interrogation.
Conclusion
Although our findings are broadly consistent with the previous reports of subcutaneous GA, the sonographic features in localized, generalized, and perforating GA have not been previously reported.
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References
Piette EW, Rosenbach M (2016a) Granuloma annulare: clinical and histologic variants, epidemiology, and genetics. J Am Acad Dermatol 75:457–465
Piette EW, Rosenbach M (2016b) Granuloma annulare: pathogenesis, disease associations and triggers, and therapeutic options. J Am Acad Dermatol 75:467–479
de Barcaui EO, Carvalho AC, Lopes FP et al (2016) High frequency ultrasound with color Doppler in dermatology. An Bras Dermatol 9:262–273
Echeverría-García B, Borbujo J, Alfageme F (2014) The use of ultrasound imaging in dermatology. Actas Dermosifiliogr 105:887–890
Navarro OM (2011) Soft tissue masses in children. Radiol Clin N Am 49:1235–1259
Vázquez-Osorio I, Quevedo A, Rodríguez-Vidal A et al (2018) Usefulness of ultrasonography in the diagnosis of subcutaneous granuloma annulare. Pediatr Dermatol 35:e200-201
Stenzel M, Voss U, Mutze S et al (2010) A pretibial lump in a toddler—sonographic findings in subcutaneous granuloma annulare. Ultraschall Med 31:68–70
Riebel T, Scheer I (2011) Subcutaneous annular granuloma: a differential diagnosis not to be forgotten in expansive lower leg (soft-tissue) lesions of young children. Ultraschall Med 32:604–607
Rodríguez Bandera AI, Stewart N, Beato MJ et al (2018) Comment on “Usefulness of ultrasonography in the diagnosis of subcutaneous granuloma annulare.” Pediatr Dermatol 35:875–876
Pederiva F, Paloni G, Berti I (2017) Subcutaneous granuloma annulare: a diagnostic conundrum-learning from mistakes. Pediatr Emerg Care 33:e30-31
Lee JY, Kim SM, Fessell DP et al (2011) Sonography of benign palpable masses of the elbow. J Ultrasound Med 30:1113–1119
Floyd MS Jr, Kokai G, McAndrew HF (2011) Granuloma annulare of the penis in a seven-year-old boy. Scand J Urol Nephrol 45:77–79
Cheung VYT (2018) Ultrasonography of benign vulvar lesions. Ultrasonography 37:355–360
Wortsman X, Alfageme F, Roustan G et al (2016) Proposal for an assessment training program in dermatologic ultrasound by the DERMUS Group. J Ultrasound Med 35:2305–2309
Vidal D, Ruiz-Villaverde R, Alfageme F, Roustan G, Mollet J, Ruiz-Carrascosa JC, Haychein S, Gavin J, Arias-Santiago S, Martorell A, Velasco-Pastor M. Use of high frequency ultrasonography in dermatology departments in Spain. Dermatol Online J. 2016;22(2):13030/qt0249s215. Retrieved from https://escholarship.org/uc/item/0249s215
Corvino A, Sandomenico F, Corvino F et al (2020) Utility of a gel stand-off pad in the detection of Doppler signal on focal nodular lesions of the skin. J Ultrasound 23:45–53
Catalano O, Alfageme F, Varelli C et al (2019) Skin cancer: findings and role of high-resolution ultrasound. J Ultrasound 22:423–431
Esposito F, Ferrara D, Di Serafino M et al (2019) Classification and ultrasound findings of vascular anomalies in pediatric age: the essential. J Ultrasound 22:13–25
Catalano O, Varelli C, Sbordone C et al (2020) A bump: what to do next? Ultrasound imaging of superficial soft-tissue palpable lesions. J Ultrasound 23:287–300
García-Martínez FJ, Muñoz-Garza FZ, Hernández-Martín A (2015) Ultrasound in pediatric dermatology. Actas Dermosifiliogr 106:76–86
Rodríguez Bandera AI, Sebaratnam DF, Feito Rodríguez M et al (2020) Cutaneous ultrasound and its utility in pediatric dermatology. Part I: lumps, bumps, and inflammatory conditions. Pediatr Dermatol. 37:29–39
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by NR-G and FJG-M. The first draft of the manuscript was written by NR-G and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Rodríguez-Garijo, N., Tomás-Velázquez, A., Estenaga, A. et al. Granuloma annulare subtypes: sonographic features and clinicopathological correlation. J Ultrasound 25, 289–295 (2022). https://doi.org/10.1007/s40477-020-00532-0
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DOI: https://doi.org/10.1007/s40477-020-00532-0