Pilomatrixoma and its Imitators

Introduction: Pilomatrixomas are benign neoplasms derived from hair follicle matrix cells. They are among the most common soft tissue head and neck tumors of childhood. Pilomatrixomas are typically isolated, slow-growing, firm, nontender masses that are adherent to the epidermis but mobile in the subcutaneous plane. This clinical presentation is so characteristic that many experienced surgeons will excise suspected pilomatrixomas without prior imaging. We reviewed the results of this approach to determine whether physical examination alone differentiates pilomatrixomas from other similar soft tissue lesions of the pediatric head and neck. Methods: Computerized review of all pilomatrixomas over a 20-year period in a single academic pediatric otolaryngology practice. Results: 18 patients presented to our pediatric otolaryngology practice between 2001 and 2021 with historical and physical findings consistent with pilomatrixoma. Of the 18 patients, 7 were male and 11 were female. Ages ranged from 1.5 to 14 years, with a mean of 7.5 years. Most of the lesions (12) were located in the head and face, while the rest (6) were found in the neck. All patients were treated with complete surgical excision. Pathology confirmed pilomatrixoma in 15 patients. The remaining 3 children were found to have an epidermal inclusion cyst, a ruptured trichilemmal cyst, and a giant molluscum contagiosum lesion, respectively. One additional patient presented with a small lesion of the auricular helix that was thought to be a dermoid cyst, but proved to be a pilomatrixoma on histologic examination. Discussion: As pilomatrixomas are common and have a very characteristic presentation, surgical excision without prior diagnostic imaging will lead to correct treatment in the majority of cases. High resolution ultrasonography can help to confirm the diagnosis preoperatively, but is not definitive in large case series. Most of the cystic lesions that imitate pilomatrixoma will ultimately require surgical excision.

High-Resolution Ultrasonography in the Assessment of Lumbar Radiculoplexus Neuropathy in Diabetics: Preliminary Results of a Case–Control Study

Background The traditional diagnosis of lumbar radiculoplexus neuropathy (LRN) is based on a classical sequence of symptoms and targeted electrodiagnostic examination by means of electromyography. Ultrasonography reliably indicates the level of lumbar radiculopathy by assessing edema mesial to the site of compression. Materials and Methods This case–control study was undertaken at a tertiary care hospital between July 2017 and June 2019 on 15 diabetic patients with symptoms of LRN. Fifteen healthy volunteers with no symptoms or clinical signs of LRN were included in the control group. The diameter (D) and transverse diameter (TD) of L1 nerve root (L1NR), L2NR, L3NR, and L4NR were measured, and their cross-sectional areas (CSAs) were calculated based on location in the lateral zone, where the NRs were visualized. On high-resolution ultrasonography, femoral nerve was localized lateral to the femoral artery in the femoral triangle beneath the inguinal ligament. Additionally, the CSA (calculated as CSA [mm2] = D × TD × π/4), the diameter (mm), and transverse diameter (mm) of bilateral femoral nerves at the level of L3-L4 were calculated. Results The difference attributed to CSAs between affected NRs in LRN group and unaffected NRs in controls at levels L1-L4 was considered statistically significant (p < 0.05). Receiver operating characteristic analysis revealed mean values to be 8 mm2 (CSA) for L1NR, 11.2 mm2 (CSA) for L2NR, 13.6 mm2 (CSA) for L3NR, and 17.8 mm2 (CSA) for L4NR. There was significant difference between ΔCSA of LRN patients and controls at L1 to L4 levels (p < 0.05). CSA measurements of lateral femoral cutaneous nerve (8 mm2) and femoral nerve (58 mm2) performed on high-resolution ultrasonography were significantly larger on the affected side as compared with the unaffected side. Conclusion Radiculoplexus neuropathy of the lumbar plexus can be reliably diagnosed on high-resolution ultrasonography that can reveal nerve thickening. The laterality of affected NRs was significantly greater in LRN group when compared with controls.

Applications of Advanced Ultrasound Technology in Obstetrics

Over the years, there have been several improvements in ultrasound technologies including high-resolution ultrasonography, linear transducer, radiant flow, three-/four-dimensional (3D/4D) ultrasound, speckle tracking of the fetal heart, and artificial intelligence. The aims of this review are to evaluate the use of these advanced technologies in obstetrics in the midst of new guidelines on and new techniques of obstetric ultrasonography. In particular, whether these technologies can improve the diagnostic capability, functional analysis, workflow, and ergonomics of obstetric ultrasound examinations will be discussed.

Diagnostic Pitfalls in an Atypical Case of Primary Neuritic Leprosy

Primary neuritic leprosy is a form of leprosy clinically limited to the peripheral nerves without obvious skin lesions. Diagnosing leprosy in the absence of typical dermatological features is challenging and often causes a delay in diagnosis. We describe a case of primary neuritic leprosy with atypical features and the roles that histological confirmation using nerve biopsy of an unenlarged nerve and newer techniques, such as polymerase chain reaction and high-resolution ultrasonography, play in improving the diagnosis.