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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5765_Библиотеки_им_академика_М_И_Перельмана.pdf
242
8 Ultrasound ofNail Conditions
a
b
Fig. 8.22 Glomus tumor (distal location). (a) Clinical photograph.
(b–e) Ultrasound images (b and c, Greyscale [b, longitudinal; c, transverse]; d, color Doppler; e, 3D reconstruction) show 3.6-mm (longitudinal) × 1.9-mm (transverse) × 1.8-mm (thickness) well-dened
hypoechoic solid nodule at the distal part of the nail bed. Notice the
hypervascularity (d, arrow) within the nodule on color Doppler and the
scalloping of the bony margin (e, arrow) as is shown in the 3D reconstruction. Video 8.12.
8.4 Benign Tumors andPseudotumors
243
Fig. 8.22 (continued)
c
d
e
244
8 Ultrasound ofNail Conditions
Fibrous Tumor
Denition
Heterogeneous group of brous tumors that may include
congenital conditions (such as Koenen’s bromas in
patients with tuberous sclerosis) and acquired brous
tumors, with eccentric location in the nail bed and periungual region.
a
Key Sonographic Signs
• Hypoechoic structures with oval, round, fusiform, or polypoid shape
• Eccentric location in the nail bed
• Involvement of the periungual region and matrix wing
(common)
• Scalloping of the bony margin in large-sized tumors
• Commonly hypovascular, except for angiobromas that
can show thin, low-ow arterial and venous vessels
(Figs.8.23 and 8.24, Video 8.13) [1, 2, 17]
Fig. 8.23 Fibrous tumor.
(a)Clinical photograph of the
nail of the right hallux.
(b–f)Ultrasound images (bandc,
greyscale; b, longitudinal;
c,transverse views; d, color
Doppler, longitudinal view;
e,comparison side by side
between the lateral and medial
aspects of the nail of the right
hallux; f, 3D reconstruction,
longitudinal view) show
well- dened, oval-shaped
hypoechoic and hypovascular
structure (asterisks) in the
proximal and lateral parts of the
nail bed that involves the lateral
wing of the matrix region.
b
c
8.4 Benign Tumors andPseudotumors
Fig. 8.23 (continued)
245
d
e
f
246
ac
8 Ultrasound ofNail Conditions
d
b
Fig. 8.24 Fibrous tumor. (a) Clinical photograph of the nail of the
right 5th toe. (b–d) Ultrasound images (b, greyscale; c, color Doppler;
d, 3D reconstruction; all longitudinal views) demonstrate well-dened
oval-shaped hypoechoic structure (asterisks) on top of the nail plate
originated in the nail bed, where it involves the ungual matrix. Notice
the irregular thickening of the nail plate, probably secondary to the
involvement of the nail matrix. On color Doppler, thin vessels (colors)
are detected within the tumor (in colors).
8.4 Benign Tumors andPseudotumors
247
Onychomatricoma
Denition
Fibroepithelial tumor of the ungual matrix.
Key Sonographic Signs
• Hypoechoic structure with hyperechoic spots or lines
(Figs.8.25, 8.26, and 8.27, Video 8.14)
a
• Located in the proximal part of the nail bed
• Involvement of the nail matrix region
• Extends into the interplate space (common)
• Eccentric
• Hypovascular or intermediate degree of vascularity within
the tumor, with low-ow vessels [1, 2, 17, 18].
b
Fig. 8.25 Onychomatricoma. (a) Clinical photograph of the nail of the
right middle nger. (b–d) Ultrasound images (b, greyscale, longitudinal
view; c, color Doppler, longitudinal; d, 3D reconstruction, longitudinal)
show hypoechoic structure (o) in the proximal part and radial aspect of
the nail bed that involves the matrix region. The tumor presents hyperechoic lines (arrows and arrowheads) and extends into the interplate
space. On color Doppler, few and thin vessels are detected within the
tumor region (in colors). Video 8.13.
248
8 Ultrasound ofNail Conditions
c
d
Fig. 8.25 (continued)
ac
8.4 Benign Tumors andPseudotumors
e
b
f
249
d
Fig. 8.26 Onychomatricoma. (a) Clinical image of the nail of the left
thumb. (b–f) Ultrasound images (b–d, greyscale; b, longitudinal view;
c, transverse; d, comparison right to left, longitudinal; e, color Doppler,
longitudinal; f, 3D reconstruction, longitudinal) demonstrate
hypoechoic structure (o) in the proximal part and medial aspect of the
nail bed; it presents hyperechoic lines (arrows and arrowheads) and
extends into the interplate space. On color Doppler (e), low vascularity
(in colors) is observed within the tumor region (o).
250
8 Ultrasound ofNail Conditions
a
Fig. 8.27 Onychomatricoma. (a) Clinical image of the nail of the left
middle nger. Notice the hyperpigmentation of the tumor; melanoma was
among the clinical differential diagnoses. (b–d) Ultrasound images (b,
Greyscale; c, color Doppler; d, 3D reconstruction; all longitudinal views)
show a hypoechoic structure (o) in the proximal part and ulnar aspect of
the nail bed, with hyperechoic spots and lines (arrows) that extend into
the interplate space. On color Doppler (c), an intermediate degree of vascularity is detected within the tumor region (in colors). Video 8.14.
8.4 Benign Tumors andPseudotumors
b
c
251
Fig. 8.27 (continued)
d