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- Author or Editor: Ximena Wortsman x
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Retronychia, the posterior embedding of the nail bed into the proximal nail fold, can be a complex clinical dermatologic diagnosis that may mimic other inflammatory ungual diseases or tumors of the nail. It has been related to a history of severe systemic conditions that secondarily affect the nail matrix and is commonly associated with onychomadesis. We present a case of retronychia of the foot with a purely traumatic origin, nonconcomitant with onychomadesis, that was diagnosed by color Doppler ultrasound in a long-time practitioner of martial arts who was otherwise healthy. Color Doppler ultrasound is an excellent imaging technique for supporting the diagnosis of retronychia. It provides information on the exact location and morphology of the nail plate as well as the presence of inflammatory signs in the ungual and proximal periungual regions. Additionally, this imaging technique can support the differential diagnosis with other nail conditions. Since there are many sports or activities that can potentially injure the toenails, retronychia may be an underestimated entity and the present case can raise the awareness of this condition and show the usefulness of color Doppler ultrasound.
We show an unusual presentation of a schwannoma that was located in the ungual bed of the left great toe. The clinical, color Doppler ultrasound imaging, and histologic findings are shown to illustrate the case. This type of neurogenic tumor and the ultrasound presurgical imaging support should be considered when dealing with subungual tumors of the foot.
We present the ultrasonographic morphology of an actinomycetoma of the foot at 18 and 70 MHz (high-frequency and ultrahigh-frequency ultrasound, respectively), and describe an ultrasonographic sign that may help to discriminate between eumycetoma and actinomycetoma called the “bright hyperechoic halo.” To date, this is the first report on the morphology of mycetoma at 70 MHz with a clinical, ultrasonographic, and histologic correlation of the images, which provides ultrasound images that are very similar to the lower magnification of histology.
Acrokeratoelastoidosis (AKE) is a rare form of focal acral keratoderma of unknown cause that typically begins during childhood and manifests with multiple, small, hyperkeratotic papules located over the lateral margins of the hands and feet. The purpose of this article is to report a pediatric case of AKE with dermoscopic, sonographic, and histopathologic descriptions, contributing to the awareness of this clinical diagnosis. We describe a 7-year-old girl with nonpainful yellowish papules on the lateral and medial aspects of both feet. Dermoscopy showed yellowish, structureless, linear areas. The sonographic appearance was suggestive of benignancy and ruled out the presence of piezogenic pedal papules and granulomas. Histopathology was consistent with AKE, showing acral skin with hyperorthokeratosis, hypergranulosis, and elastorrhexis in the reticular dermis. Acrokeratoelastoidosis may be difficult to recognize clinically because of its resemblance to other focal acral keratodermas. Color Doppler ultrasound can be a useful noninvasive tool for diagnosis and can confirm its benign appearance, although histopathology confirms the definitive diagnosis. To date, the dermoscopic description and ultrasound morphology of AKE have not been reported.
