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Ximena Wortsman - Atlas of Dermatologic Ultrasound

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Ximena Wortsman Atlas of Dermatologic Ultrasound

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This atlas presents a practical and systematic approach for performing dermatologic ultrasound. In recent years, the use of this imaging modality for diagnosing pathologic conditions of the skin, hair, nails, scalp, and soft tissues has grown dramatically and there is a demonstrated need for quick access to this information. For common dermatologic entities, richly-illustrated figures and drawings describe the ultrasound normal anatomy, technical guidelines, common findings, variants, key points, and tips and pitfalls. The extensive collection includes clinical and ultrasonographic correlations with 3D color Doppler ultrasound images and high-definition videos produced with state-of-the-art technology and relevant topics such as benign cutaneous and nail tumors and pseudotumors, skin cancer, vascular anomalies, facial ultrasound anatomy for cosmetic purposes, aesthetic complications, inflammatory diseases, etc. The Atlas of Dermatologic Ultrasound is a valuable resource and a must-have book for radiologists, dermatologists, plastic surgeons, sonographers, residents, and medical professionals who wish to strengthen their knowledge of the wide spectrum of sonographic presentations of dermatologic conditions and successfully integrate this field of ultrasound into their clinical practice.

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Ximena Wortsman Atlas of Dermatologic Ultrasound Ximena Wortsman - photo 1
Ximena Wortsman
Atlas of Dermatologic Ultrasound
Ximena Wortsman IDIEP Institute for Diagnostic Imaging and Research of the - photo 2
Ximena Wortsman
IDIEP, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile
Department of Dermatology, Universidad de Chile, Santiago, Chile
Department of Dermatology, Pontificia Universidad Catlica de Chile, Santiago, Chile
ISBN 978-3-319-89613-7 e-ISBN 978-3-319-89614-4
https://doi.org/10.1007/978-3-319-89614-4
Library of Congress Control Number: 2018940395
Springer International Publishing AG, part of Springer Nature 2018
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This Springer imprint is published by Springer Nature, under the registered company Springer International Publishing AG.

The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Preface

In preparing this atlas, I have been thinking of the young medical generation, who look for quick answers and are used to high-tech tools. This group includes my daughter Camila, who has recently started her medical road. It was also done while thinking of those readers who are curious and avid for information in the field of dermatologic ultrasound.

The book is divided into 10 chapters that contain common, challenging topics for those practicing this field of imaging. The chapters that show pathology are subdivided by conditions and present illustrative images and some references to review.

All images are of high resolution and were performed on state-of-the-art equipment. They show a nice correlation between clinical and sonographic images.

A practical approach to each condition is presented, with focus on its key sonographic signs. Some videos are also available, which provide an idea of the rich data available in these dynamic, real-time imaging studies.

I hope that this book will support and motivate each readers dermatologic ultrasound practice.

Ximena Wortsman
Santiago, Chile
May 2018
Acknowledgments

Special thanks to the contributors, Dr. Natacha Quezada and Dr. Marcio Bouer, and special thanks to Camila Ferreira-Wortsman, MS, who have generously supported this book.

To the staff of the Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues (IDIEP), particularly to Adelina Varela, Geraldine Cocca, Veronica Pacheco, and Pilar Moreno, who have helped me daily in the task of gathering the data to build this book.

To the Departments of Dermatology of the University of Chile and the Pontifical Catholic University of Chile, as well as the members of the Chilean Society of Dermatology, which have encouraged me to follow in this continuous line of work.

To my family, especially my parents Gloria Cnovas and Isaias Wortsman, my brothers Claudio and Marcelo, and my children Benjamin and Camila, who have always supported me on this road.

Contents
Ximena Wortsman
Ximena Wortsman
Ximena Wortsman
Ximena Wortsman
Ximena Wortsman
Ximena Wortsman , Camila Ferreira-Wortsman and Natacha Quezada
Ximena Wortsman
Ximena Wortsman
Ximena Wortsman
Marcio Bouer and Ximena Wortsman
Index
Contributors
Marcio Bouer MD
Department of Radiology, Fleury Laboratory, So Paulo, Brazil
Camila Ferreira-Wortsman MS
Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
Natacha Quezada MD
Department of Dermatology, Pontificia Universidad Catolica de Chile, Hospital Clinico Universidad Catlica, Santiago, Chile
Ximena Wortsman MD
IDIEP, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile
Department of Dermatology, Universidad de Chile, Santiago, Chile
Department of Dermatology, Pontificia Universidad Catlica de Chile, Santiago, Chile
Springer International Publishing AG, part of Springer Nature 2018
Ximena Wortsman Atlas of Dermatologic Ultrasound https://doi.org/10.1007/978-3-319-89614-4_1
1. Normal Ultrasound Anatomy of the Skin, Nail, and Hair
Ximena Wortsman
(1)
IDIEP, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile
(2)
Department of Dermatology, Universidad de Chile, Santiago, Chile
(3)
Department of Dermatology, Pontificia Universidad Catlica de Chile, Santiago, Chile
Ximena Wortsman
Email:
Keywords
Dermatologic ultrasound Skin ultrasound Ultrasound dermatology Nail ultrasound Hair ultrasound Dermatologic ultrasound normal anatomy Ultrasound dermatology anatomy
1.1 Ultrasound Anatomy of the Skin
The skin is composed of three layers (Fig. ]:
  • The epidermis is the outer layer; in most regions of the body, it appears as a hyperechoic line owing to its keratin content (Fig. ).

  • The dermis is located beneath the epidermis and appears as a hyperechoic band, less bright than the epidermis. The echogenicity of the dermis is due mainly to its collagen content. There are regional differences in the thickness of the dermis. For example, the dermis is thin in the face and ventral forearm, but thicker in the dorsal region. This variability may provide a major possibility of involvement of deeper layers in the regions that present a thinner dermis, such as the face. In photoaged skin, a subepidermal low-echogenic band (SLEB) is detected in the regions exposed to the sun; this band corresponds to the deposits of glycosaminoglycan in the upper dermis (Fig. ). It should not be confused with inflammatory cutaneous diseases such as morphea.

  • The hypodermis , also called subcutaneous tissue or subcutis , shows as a hypoechoic layer because of its fatty lobules. Between the fatty lobules are hyperechoic, linear fibrous septa.

Fig 11 Drawing of the normal anatomy of the skin Fig 12 Normal ultras - photo 3
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