Skin sonography in children: a review

Skin sonography in children: a review

REVIEWED BY Cain Brockley, FASA | ASA SIG: Paediatric

REFERENCE | Authors: Garcia C, Wortsman X, BazaesNunez D et al.

WHY THE REVIEW WAS PERFORMED

To demonstrate the wide range of paediatric skin lesions that occur and to demonstrate the use of clinical and sonographic correlation in the diagnosis of these common skin lesions. The review is a useful reference to help any sonographer and/or radiologist performing these types of examinations. Improved sonographic diagnosis can reduce the need for more complex imaging such as MRI, which is more difficult in the paediatric age group, and also potentially reduce any unnecessary surgery.

“A clinical sonographic correlation is required to improve the correct diagnosis rate when scanning paediatric skin lesions.”

WHAT THE REVIEW IS ABOUT

The review covers a wide range of lesions, with emphasis placed on the need for good clinical sonographic correlation. The article is broken down into the following categories:

Technical recommendations

The minimum technical requirements and recommendations for performing dermatological sonographic examinations are described, with emphasis on the use of high frequency ultrasound and the need for B-mode, colour and spectral Doppler.

Skin anatomy & sonographic appearance

A brief review of skin anatomy, including the various layers and their composition, is provided with the corresponding normal sonographic appearance.

Skin lesions

The skin lesions are broken down into multiple categories including benign and pseudotumoural, malignant, inflammatory and miscellaneous lesions. It must be noted that this article does not cover vascular anomalies.

Each lesion is well described with both clinical features, common locations and sonographic appearances well detailed, including descriptions of specific features that can help to delineate between similar lesions. Most of the lesions described are benign as these are far more common in children. The benign lesions cover a wide range of cystic and solid lesions that occur superficially. Though malignant skin lesions are rare in the paediatric population, the article does include this topic with emphasis on certain clinical features such as rapid growth, firm consistency, non-mobility, and ulceration to be aware of when performing the examination. Multiple miscellaneous lesions are covered. One example is fat necrosis in the newborn, which is useful to understand and identify because, though benign itself, it has a strong association with other underlying conditions such as hypercalcemia.

RELEVANCE TO CLINICAL PRACTICE

Skin lesions often cause a high level of anxiety in parents and/or patients, therefore are a common presentation for sonographic examination in most practices and departments. Given the range of common lesions that can occur, which thankfully are mostly benign, this review provides a good resource for sonographers and radiologists to assist in narrowing down the diagnosis, but also to help identify those lesions that are more concerning for malignancy and need further examination. Identifying the benign lesions can provide reassurance to parents, help to guide treatment if required, and reduce unnecessary surgery. A sound knowledge of the various common lesions that occur and their sonographic appearances combined with a good clinical history can significantly improve the diagnostic outcomes.