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Case and Research Letters
Pseudoflow in adnexal skin tumors
Pseudoflujo en tumores anexiales cutáneos
L. Turrión-Merino
Autor para correspondencia
luciaturrion@gmail.com

Corresponding author.
, F. Alfageme-Roldán, I. Salgüero-Fernández, C. Martínez-Mera, G. Roustan-Gullon
Servicio de Dermatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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    "titulo" => "Pseudoflow in adnexal skin tumors"
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        "titulo" => "Pseudoflujo en tumores anexiales cut&#225;neos"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">CASE 1&#46; &#40;A&#41; Clinical image&#58; bluish nodule located on the left cheek&#46; &#40;B&#41; US image&#46; B-mode&#58; Subdermal heterogenic hypoechoic cystic lesion&#46; &#40;C&#41; US image&#46; Color-Doppler&#58; turbulent color Doppler flow&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The use of ultrasound &#40;US&#41; in dermatology is highly extended specially for the diagnosis of malignant and benign neoplasms&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> in addition color and power Doppler US allow assessment of tissue vascularity&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> However a variety of Doppler artifacts have been documented in the literature&#46;<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&#46; No previous reports of this Doppler artifact in skin tumors have been published in the reviewed literature&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">CASE 1&#58; We present the case of an 80-year-old woman with a bluish papule of indeterminate time of evolution located on the left cheek &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The lesion was asymptomatic&#46; Ultrasound showed a subdermal hypoechoic cystic lesion with turbulent color Doppler flow &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Venous ectasia was suspected and surgical removal was performed&#46; The final histopathology diagnosis was hidrocystoma&#46; CASE2&#58; The second case was a 72-year-old man with a translucent nodule in the right temple &#40;Figure 3&#41;&#46; Clinical diagnosis was suggestive of a hidrocystoma&#46; In the US exploration we also observed a hypoechoic cystic lesion with turbulent color Doppler flow &#40;Figure 4&#41;&#46; Final histopathology diagnosis was consistent with clinical diagnosis of hidrocystoma&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Chin and associates evaluated several hidrocytomas using US&#46; They suggested that these structures showed a cystic lesion with hyperechoic surface and either a hypoechoic center &#40;lipofuscin debris&#41; or an echolucent center &#40;clear fluid&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Perez-Lopez et al&#46; stressed the absence of flow inside this structures&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> However&#44; in our cases we have seen that sometimes this structures can show positive Doppler signal&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Because color and power Doppler US are used to asses tissue vascularity&#44; it is tempting when one finds a positive Doppler signal&#44; to assume the color in the image to blood flow&#46; However this assumption can lead to misinterpretation&#46;<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&#44; and appears similar to real blood flow at color or power Doppler US&#46; The color or power Doppler signal will appear as long as the fluid motion continues&#46; But if we use Spectral analysis&#44; it shows a pattern inconsistent with vascular flow&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Histologically&#44; hydrocystomas are characterized by presenting a cystic appearance&#44; with a wall composed by epithelium&#44; and the lumen containing variable amounts of secretions&#46; Intralesional fluid movement has been recently reported by Dr&#46; Wortsman in a recent series of apocrine hydradenomas&#44; in which fluid movement could be detected even in B mode&#44; confirming intralesional fluid movement in this kind of adnexal skin tumors&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In our cases&#44; 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&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Knowledge of the color and power Doppler artifacts&#44; and the use of spectral analysis will prevent misinterpretation of these artefactual pitfalls and may improve diagnosis accuracy&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Turri&#243;n-Merino L&#44; Alfageme-Rold&#225;n F&#44; Salg&#252;ero-Fern&#225;ndez I&#44; et al&#46; Pseudoflujo en tumores anexiales cut&#225;neos&#46; Actas Dermosifiliogr&#46; 2020&#59;111&#58;621&#8211;622&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CASE 2&#46; &#40;A&#41; Clinical image&#58; translucent nodule on the right temple&#46; &#40;B&#41; US image&#46; B-Mode&#58; hypoechoic cystic lesion&#46; &#40;C&#41; US image&#46; Color-Doppler&#58; turbulent color Doppler&#46;</p>"
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