Case and Research Letters
Ultrasound Diagnosis of Calcified Skin Deposits
Depósitos cálcicos cutáneos diagnosticados mediante ecografía
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C, Granuloma annulare lesions can be observed on the dorsum of the left foot.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Martín-Callizo, J. Marcoval, R.M. Penín" "autores" => array:3 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Martín-Callizo" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Marcoval" ] 2 => array:2 [ "nombre" => "R.M." "apellidos" => "Penín" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731015000101" "doi" => "10.1016/j.ad.2014.12.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015000101?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015001808?idApp=UINPBA000044" "url" => "/15782190/0000010600000007/v1_201508271313/S1578219015001808/v1_201508271313/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1578219015001778" "issn" => "15782190" "doi" => "10.1016/j.adengl.2015.06.012" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "1151" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "article" "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2015;106:585" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1141 "formatos" => array:3 [ "EPUB" => 50 "HTML" => 874 "PDF" => 217 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images en Dermatology</span>" "titulo" => "Long-Standing Presternal Plaque" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "585" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Placa preesternal de larga evolución" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 663 "Ancho" => 1300 "Tamanyo" => 197689 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Presternal plaque of 15<span class="elsevierStyleHsp" style=""></span>x<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>cm formed by the coalescence of multiple erythematous-violaceous tumors with maximum individual diameters of 2-3<span class="elsevierStyleHsp" style=""></span>cm.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "G. 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Lorente-Luna, F. Alfageme Roldán, C. González Lois" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Lorente-Luna" "email" => array:1 [ 0 => "m.lorente.luna@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "F." "apellidos" => "Alfageme Roldán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "González Lois" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Central de la Defensa Gómez-Ulla, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Depósitos cálcicos cutáneos diagnosticados mediante ecografía" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1182 "Ancho" => 995 "Tamanyo" => 139422 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Ultrasound image. B mode: sagittal section showing increased thickness and decreased echogenicity of the dermis, compatible with inflammation, and hyperechoic deposits with a linear morphology that produce an acoustic shadow. The deposits are located in the dermis and in the subcutaneous cellular tissue. B, Ultrasound image. Doppler study: absence of flow.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Calcified deposits in the skin are rare.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> When they are formed of mature bone with the presence of trabeculae they are called ossification, whereas deposits of amorphous material are called calcification. The presence of calcium on histology is diagnostic, though this can be difficult in some cases. Ultrasound is a rapid, noninvasive technique that provides in vivo information that can be very useful for the study of these lesions.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> We present the case of a 71-year-old woman whose relevant past history included systemic lupus, kidney failure, and secondary hyperparathyroidism. She was on long-term treatment with risendronate, torasemide, allopurinol, and prednisone. She was seen for painful lesions that had arisen on her legs 4 months earlier.</p><p id="par0010" class="elsevierStylePara elsevierViewall">On physical examination, both legs were indurated and presented hyperpigmentation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A) with hard, well-defined subcutaneous nodules over which there were brownish-erythematous macules with a reticular pattern (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). The blood tests gave the following results related to her underlying disease: hemoglobin, 10.7<span class="elsevierStyleHsp" style=""></span>mg/dL; creatinine, 1.8<span class="elsevierStyleHsp" style=""></span>mg/dL; urea, 119<span class="elsevierStyleHsp" style=""></span>mg/dL; sodium, 138<span class="elsevierStyleHsp" style=""></span>mmol/L; potassium, 4.7<span class="elsevierStyleHsp" style=""></span>mmol/L; parathyroid hormone, 114<span class="elsevierStyleHsp" style=""></span>pg/mL; calcium, 9<span class="elsevierStyleHsp" style=""></span>mg/dL; phosphorus, 3.7<span class="elsevierStyleHsp" style=""></span>mg/dL. Ultrasound study (Esaote My Lab One with a variable frequency linear array of 18-22<span class="elsevierStyleHsp" style=""></span>MHz with a lateral resolution of 240<span class="elsevierStyleHsp" style=""></span>μm) demonstrated a thickened and hypoechoic dermis, suggestive of inflammation, and hyperechoic deposits with a density similar to bone and with a linear morphology. These deposits were located in the dermis and in the subcutaneous cellular tissue and left an acoustic shadow (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). Flow was absent on Doppler study (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). Skin biopsy revealed fibrotendinous tissue with mature cartilage (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Despite the lack of histological confirmation, the diagnosis of calcium deposits was supported by the clinical manifestations and the ultrasound findings. The patient died due to rupture of an aneurysm of an internal iliac artery and no further tests could be performed.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Soft-tissue calcifications have been associated with rheumatologic disorders, although they are considered rare in systemic lupus erythematosus.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> Since 1975, soft-tissue calcifications have been classified into various subtypes: metastatic, dystrophic, idiopathic, tumoral, and calciphylaxis. Metastatic calcifications appear in healthy tissue and are due to changes in phosphorus and calcium metabolism. They are associated with hyperparathyroidism and tumors. Dystrophic calcifications develop without changes in phosphorus and calcium metabolism, in tissues previously damaged by diseases such as lupus, scleroderma, or dermatomyositis. Tumoral calcifications are due to a genetic disorder, with lesions in pressure areas and close to joints. Idiopathic calcifications develop in otherwise healthy individuals. Calciphylaxis is characteristic of patients with advanced chronic kidney failure and is due to calcification of the walls of small vessels.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> Ossification is much rarer and has primary forms (Albright hereditary osteodystrophy and osteoma cutis) and secondary forms that arise in scars, tissues affected by collagen diseases, and inflammatory lesions due to metaplasia of a preexisting lesion.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> The deposits are usually asymptomatic and are detected as incidental findings on x-ray. Lesions vary from whitish papules or nodules of firm consistency to skin ulcers. Ossification is harder than calcification. Livedo racemosa is a rare finding and is associated with altered venous drainage.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> Advanced lesions can cause pain, inflammation, joint deformity, and nerve entrapment. The differential diagnosis is broad. Pilomatrixomas, calcified epidermal cysts, and foreign body reactions must be ruled out when the lesions are localized, whereas panniculitis, lipodermatosclerosis, vasculitis, and vascular ulcers must be excluded when there are widespread or ulcerated lesions with inflammatory signs. To further complicate the situation, any of these dermatoses can coexist with the calcium deposits. On ultrasound, the deposits are hyperechoic, with a similar density to bone, and they produce a posterior acoustic shadow in the case of ossification. Calcifications are less echogenic.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> Skin deposits are usually oval, whereas they are linear when they arise in blood vessel walls. Ultrasound is considered to be the investigation of choice for the early diagnosis and follow-up of calcium deposits, as it is more sensitive and specific than radiography.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> Histology is the gold standard. Treatment has not been standardized. Surgical resection, intralesional corticosteroids, carbon dioxide laser therapy, and even intravenous immunoglobulin have been used to treat localized lesions, whereas diltiazem, probenecid, minocycline, aluminum hydroxide, and the bisphosphonates have been employed in widespread lesions, with favorable results in isolated cases.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> In our patient it was not possible to determine whether the lesions were calcifications or ossifications, though the clinical manifestations and ultrasound findings would suggest they were multiple secondary ossifications. Through our presentation of this case, we would like to draw attention to the increasing importance of skin ultrasound and its indications, particularly for the investigation of calcium deposits, as it has a very high sensitivity for these lesions and can be the key to diagnosis if histology is not conclusive.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lorente-Luna M, Alfageme Roldán F, González Lois C. Depósitos cálcicos cutáneos diagnosticados mediante ecografía. Actas Dermosifiliogr. 2015;106:586–588.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 679 "Ancho" => 1300 "Tamanyo" => 156844 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Clinical photograph. Symmetrical involvement of both legs, with hyperpigmentation. B, Clinical photograph. Hard, well-defined subcutaneous nodules over which brownish-erythematous macules with a reticular pattern can be observed.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1182 "Ancho" => 995 "Tamanyo" => 139422 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Ultrasound image. B mode: sagittal section showing increased thickness and decreased echogenicity of the dermis, compatible with inflammation, and hyperechoic deposits with a linear morphology that produce an acoustic shadow. The deposits are located in the dermis and in the subcutaneous cellular tissue. B, Ultrasound image. Doppler study: absence of flow.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 747 "Ancho" => 995 "Tamanyo" => 178123 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histology. Fibrotendinous tissue with mature cartilage. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 16 | 10 | 26 |
| 2024 Octubre | 220 | 51 | 271 |
| 2024 Septiembre | 205 | 42 | 247 |
| 2024 Agosto | 292 | 81 | 373 |
| 2024 Julio | 257 | 54 | 311 |
| 2024 Junio | 174 | 53 | 227 |
| 2024 Mayo | 182 | 48 | 230 |
| 2024 Abril | 177 | 35 | 212 |
| 2024 Marzo | 188 | 35 | 223 |
| 2024 Febrero | 216 | 38 | 254 |
| 2024 Enero | 273 | 31 | 304 |
| 2023 Diciembre | 306 | 27 | 333 |
| 2023 Noviembre | 306 | 26 | 332 |
| 2023 Octubre | 302 | 24 | 326 |
| 2023 Septiembre | 313 | 30 | 343 |
| 2023 Agosto | 236 | 21 | 257 |
| 2023 Julio | 189 | 39 | 228 |
| 2023 Junio | 189 | 36 | 225 |
| 2023 Mayo | 216 | 36 | 252 |
| 2023 Abril | 187 | 22 | 209 |
| 2023 Marzo | 175 | 26 | 201 |
| 2023 Febrero | 194 | 24 | 218 |
| 2023 Enero | 168 | 43 | 211 |
| 2022 Diciembre | 168 | 68 | 236 |
| 2022 Noviembre | 174 | 48 | 222 |
| 2022 Octubre | 163 | 31 | 194 |
| 2022 Septiembre | 137 | 61 | 198 |
| 2022 Agosto | 110 | 38 | 148 |
| 2022 Julio | 116 | 54 | 170 |
| 2022 Junio | 100 | 35 | 135 |
| 2022 Mayo | 127 | 56 | 183 |
| 2022 Abril | 101 | 73 | 174 |
| 2022 Marzo | 134 | 74 | 208 |
| 2022 Febrero | 98 | 49 | 147 |
| 2022 Enero | 127 | 42 | 169 |
| 2021 Diciembre | 88 | 52 | 140 |
| 2021 Noviembre | 108 | 52 | 160 |
| 2021 Octubre | 75 | 85 | 160 |
| 2021 Septiembre | 88 | 54 | 142 |
| 2021 Agosto | 87 | 52 | 139 |
| 2021 Julio | 43 | 56 | 99 |
| 2021 Junio | 49 | 43 | 92 |
| 2021 Mayo | 54 | 54 | 108 |
| 2021 Abril | 90 | 96 | 186 |
| 2021 Marzo | 85 | 31 | 116 |
| 2021 Febrero | 69 | 36 | 105 |
| 2021 Enero | 51 | 32 | 83 |
| 2020 Diciembre | 41 | 42 | 83 |
| 2020 Noviembre | 25 | 32 | 57 |
| 2020 Octubre | 53 | 29 | 82 |
| 2020 Septiembre | 43 | 19 | 62 |
| 2020 Agosto | 28 | 27 | 55 |
| 2020 Julio | 26 | 27 | 53 |
| 2020 Junio | 37 | 57 | 94 |
| 2020 Mayo | 24 | 51 | 75 |
| 2020 Abril | 34 | 27 | 61 |
| 2020 Marzo | 29 | 38 | 67 |
| 2020 Febrero | 8 | 10 | 18 |
| 2020 Enero | 5 | 7 | 12 |
| 2019 Diciembre | 9 | 9 | 18 |
| 2019 Noviembre | 5 | 4 | 9 |
| 2019 Octubre | 0 | 3 | 3 |
| 2019 Septiembre | 13 | 7 | 20 |
| 2019 Agosto | 6 | 3 | 9 |
| 2019 Julio | 4 | 7 | 11 |
| 2019 Junio | 5 | 20 | 25 |
| 2019 Mayo | 2 | 27 | 29 |
| 2019 Abril | 2 | 35 | 37 |
| 2019 Marzo | 3 | 6 | 9 |
| 2019 Febrero | 1 | 4 | 5 |
| 2019 Enero | 6 | 2 | 8 |
| 2018 Diciembre | 5 | 10 | 15 |
| 2018 Noviembre | 6 | 0 | 6 |
| 2018 Octubre | 25 | 0 | 25 |
| 2018 Septiembre | 14 | 2 | 16 |
| 2018 Agosto | 0 | 5 | 5 |
| 2018 Julio | 0 | 5 | 5 |
| 2018 Junio | 1 | 5 | 6 |
| 2018 Mayo | 0 | 2 | 2 |
| 2018 Abril | 0 | 4 | 4 |
| 2018 Febrero | 86 | 3 | 89 |
| 2018 Enero | 52 | 3 | 55 |
| 2017 Diciembre | 92 | 7 | 99 |
| 2017 Noviembre | 36 | 2 | 38 |
| 2017 Octubre | 37 | 2 | 39 |
| 2017 Septiembre | 29 | 7 | 36 |
| 2017 Agosto | 26 | 7 | 33 |
| 2017 Julio | 18 | 9 | 27 |
| 2017 Junio | 33 | 12 | 45 |
| 2017 Mayo | 30 | 27 | 57 |
| 2017 Abril | 17 | 11 | 28 |
| 2017 Marzo | 11 | 8 | 19 |
| 2017 Febrero | 19 | 9 | 28 |
| 2017 Enero | 10 | 7 | 17 |
| 2016 Diciembre | 18 | 17 | 35 |
| 2016 Noviembre | 27 | 17 | 44 |
| 2016 Octubre | 31 | 16 | 47 |
| 2016 Septiembre | 0 | 4 | 4 |
| 2016 Agosto | 0 | 5 | 5 |
| 2016 Julio | 4 | 0 | 4 |
| 2016 Junio | 11 | 2 | 13 |
| 2016 Mayo | 12 | 3 | 15 |
| 2016 Abril | 4 | 8 | 12 |
| 2016 Marzo | 6 | 3 | 9 |
| 2016 Febrero | 0 | 2 | 2 |
| 2015 Diciembre | 0 | 1 | 1 |
| 2015 Octubre | 0 | 2 | 2 |
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