Case and Research Letters
Pseudoflow in adnexal skin tumors
Pseudoflujo en tumores anexiales cutáneos
L. Turrión-Merino
, F. Alfageme-Roldán, I. Salgüero-Fernández, C. Martínez-Mera, G. Roustan-Gullon
Corresponding author
Servicio de Dermatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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A) Imagen clínica: nódulo azulado situado en la mejilla izquierda. B) Imagen US. Modo-B: lesión quística hipoecoica heterogénea subdérmica. C) Imagen US: Doppler-color: flujo turbulento de color Doppler.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Turrión-Merino, F. Alfageme-Roldán, I. Salgüero-Fernández, C. Martínez-Mera, G. Roustan-Gullon" "autores" => array:5 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Turrión-Merino" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Alfageme-Roldán" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Salgüero-Fernández" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Martínez-Mera" ] 4 => array:2 [ "nombre" => "G." 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Turrión-Merino, F. Alfageme-Roldán, I. Salgüero-Fernández, C. Martínez-Mera, G. Roustan-Gullon" "autores" => array:5 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Turrión-Merino" "email" => array:1 [ 0 => "luciaturrion@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Alfageme-Roldán" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Salgüero-Fernández" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Martínez-Mera" ] 4 => array:2 [ "nombre" => "G." "apellidos" => "Roustan-Gullon" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pseudoflujo en tumores anexiales cutáneos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 573 "Ancho" => 2076 "Tamanyo" => 141425 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">CASE 1. (A) Clinical image: bluish nodule located on the left cheek. (B) US image. B-mode: Subdermal heterogenic hypoechoic cystic lesion. (C) US image. Color-Doppler: turbulent color Doppler flow.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The use of ultrasound (US) in dermatology is highly extended specially for the diagnosis of malignant and benign neoplasms,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> in addition color and power Doppler US allow assessment of tissue vascularity.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> However a variety of Doppler artifacts have been documented in the literature.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> We described two cases of pseudoflow in the context of cutaneous hidrocystomas that can lead to an erroneous diagnosis. No previous reports of this Doppler artifact in skin tumors have been published in the reviewed literature.</p><p id="par0010" class="elsevierStylePara elsevierViewall">CASE 1: We present the case of an 80-year-old woman with a bluish papule of indeterminate time of evolution located on the left cheek (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The lesion was asymptomatic. Ultrasound showed a subdermal hypoechoic cystic lesion with turbulent color Doppler flow (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Venous ectasia was suspected and surgical removal was performed. The final histopathology diagnosis was hidrocystoma. CASE2: The second case was a 72-year-old man with a translucent nodule in the right temple (Figure 3). Clinical diagnosis was suggestive of a hidrocystoma. In the US exploration we also observed a hypoechoic cystic lesion with turbulent color Doppler flow (Figure 4). Final histopathology diagnosis was consistent with clinical diagnosis of hidrocystoma.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Chin and associates evaluated several hidrocytomas using US. They suggested that these structures showed a cystic lesion with hyperechoic surface and either a hypoechoic center (lipofuscin debris) or an echolucent center (clear fluid).<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Perez-Lopez et al. stressed the absence of flow inside this structures.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> However, in our cases we have seen that sometimes this structures can show positive Doppler signal.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Because color and power Doppler US are used to asses tissue vascularity, it is tempting when one finds a positive Doppler signal, to assume the color in the image to blood flow. However this assumption can lead to misinterpretation.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Pseudoflow is a Doppler artifact related to motion of other fluid rather than blood in the absence of a vascular structure, and appears similar to real blood flow at color or power Doppler US. The color or power Doppler signal will appear as long as the fluid motion continues. But if we use Spectral analysis, it shows a pattern inconsistent with vascular flow.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Histologically, hydrocystomas are characterized by presenting a cystic appearance, with a wall composed by epithelium, and the lumen containing variable amounts of secretions. Intralesional fluid movement has been recently reported by Dr. Wortsman in a recent series of apocrine hydradenomas, in which fluid movement could be detected even in B mode, confirming intralesional fluid movement in this kind of adnexal skin tumors.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In our cases, the movement of the interior material of the hydrocystoma led to an image in the color Doppler that can be incorrectly interpreted as vascular flow.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Knowledge of the color and power Doppler artifacts, and the use of spectral analysis will prevent misinterpretation of these artefactual pitfalls and may improve diagnosis accuracy.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-10-30" "fechaAceptado" => "2019-01-12" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Turrión-Merino L, Alfageme-Roldán F, Salgüero-Fernández I, et al. Pseudoflujo en tumores anexiales cutáneos. Actas Dermosifiliogr. 2020;111:621–622.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 573 "Ancho" => 2076 "Tamanyo" => 141425 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">CASE 1. (A) Clinical image: bluish nodule located on the left cheek. (B) US image. B-mode: Subdermal heterogenic hypoechoic cystic lesion. (C) US image. Color-Doppler: turbulent color Doppler flow.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 746 "Ancho" => 2175 "Tamanyo" => 203266 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CASE 2. (A) Clinical image: translucent nodule on the right temple. (B) US image. B-Mode: hypoechoic cystic lesion. (C) US image. Color-Doppler: turbulent color Doppler.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound in dermatology: Principles and applications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Kleinerman" 1 => "T.B. Whang" 2 => "R.L. Bard" 3 => "E.S. 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Iacob" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:8 [ "tituloSerie" => "Optometry" "fecha" => "2003" "volumen" => "74" "numero" => "12" "paginaInicial" => "760" "paginaFinal" => "764" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14677727" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1888989116000240" "estado" => "S300" "issn" => "18889891" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Utility of skin ultrasound in the differential diagnosis of blue lesions, hydrocysts" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I. Perez-Lopez" 1 => "C. Garrido-Colmenero" 2 => "G. Blasco-Morente" 3 => "J. Aneiros-Fernandez" 4 => "S. Arias-Santiago" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Dermatol Online J." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 7 | 13 |
| 2024 October | 80 | 53 | 133 |
| 2024 September | 96 | 25 | 121 |
| 2024 August | 107 | 63 | 170 |
| 2024 July | 75 | 31 | 106 |
| 2024 June | 90 | 38 | 128 |
| 2024 May | 69 | 37 | 106 |
| 2024 April | 93 | 18 | 111 |
| 2024 March | 73 | 25 | 98 |
| 2024 February | 68 | 31 | 99 |
| 2024 January | 51 | 29 | 80 |
| 2023 December | 66 | 19 | 85 |
| 2023 November | 59 | 48 | 107 |
| 2023 October | 63 | 24 | 87 |
| 2023 September | 68 | 31 | 99 |
| 2023 August | 36 | 14 | 50 |
| 2023 July | 46 | 25 | 71 |
| 2023 June | 45 | 28 | 73 |
| 2023 May | 43 | 24 | 67 |
| 2023 April | 35 | 18 | 53 |
| 2023 March | 49 | 28 | 77 |
| 2023 February | 48 | 20 | 68 |
| 2023 January | 33 | 31 | 64 |
| 2022 December | 52 | 47 | 99 |
| 2022 November | 28 | 29 | 57 |
| 2022 October | 27 | 19 | 46 |
| 2022 September | 18 | 35 | 53 |
| 2022 August | 23 | 25 | 48 |
| 2022 July | 19 | 23 | 42 |
| 2022 June | 27 | 26 | 53 |
| 2022 May | 31 | 47 | 78 |
| 2022 April | 34 | 21 | 55 |
| 2022 March | 38 | 48 | 86 |
| 2022 February | 30 | 23 | 53 |
| 2022 January | 52 | 37 | 89 |
| 2021 December | 36 | 35 | 71 |
| 2021 November | 41 | 40 | 81 |
| 2021 October | 37 | 52 | 89 |
| 2021 September | 32 | 39 | 71 |
| 2021 August | 29 | 31 | 60 |
| 2021 July | 19 | 26 | 45 |
| 2021 June | 28 | 25 | 53 |
| 2021 May | 35 | 41 | 76 |
| 2021 April | 70 | 78 | 148 |
| 2021 March | 33 | 19 | 52 |
| 2021 February | 44 | 31 | 75 |
| 2021 January | 19 | 15 | 34 |
| 2020 December | 27 | 23 | 50 |
| 2020 November | 23 | 14 | 37 |
| 2020 October | 32 | 13 | 45 |
| 2020 September | 32 | 24 | 56 |
| 2020 August | 12 | 17 | 29 |
| 2020 July | 24 | 19 | 43 |
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