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1339: Pilomatricoma: The Diagnostic Value of Ultrasound
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Ultrasound in Medicine and Biology
Methods: Fifty-seven hemiplegic patients (34 men and 23 women) who participated in this study after recent stroke. According to the Brunnstrom motor recovery stage (BMRS), the subjects were divided into poor (BMRS I, II or III) and good (BMRS IV, V or VI) arm motor function groups. Using the sonography to evaluate the hemiplegic shoulder of these 2 groups on admission and before discharge undergoing in-patient rehabilitation. Results: Significant differences were found in proprioception, shoulder spasticity, shoulder subluxation, internal and external rotation of the shoulder, and VAS score of shoulder pain between the poor and good arm motor function groups (all P⬍.05). There was a significant difference in the structural changes of shoulder sonography after rehabilitation between the 2 groups (P⬍.01). Conclusions: Recent stroke patients with flaccid shoulders had significantly poor proprioception, increased muscle tone and shoulder subluxation, restricted internal and external rotation of the shoulders, and higher VAS score. According to the findings on shoulder sonography, we found the patients with poor arm function on admission was tended to have shoulder soft tissue injury during in-patient rehabilitation. 1337 Ruptured Baker’s Cyst: Assessment of Ultrasonographic Findings Soon Tae Kwon, Chungnam Naional University Hospital, Korea Jeong Eun Lee, Chungnam National University Hospital, Korea Young Mo Kim, Chungnam National University Hospital, Korea Purpose: To demonstrate the ultrasonographic (US) imaging features of ruptured Baker’s cyst (RBC). Materials and Methods: US images in 18 patients (12 women, 6 men; age range, 40-67 years; mean age, 55 years) with proven as surgical excision (n⫽5) and needle aspiration (n⫽10), including MR imaging (n⫽10), were enrolled. US imaging was obtained with a routine scan including the axial and longitudinal planes of the popliteal fossa and calf. The extended location and features of the RBC, including any associated findings, were assessed. Results: The ruptured fluid sac was located in the subcrural fascial area in eight cases, between semimembranous and medial gastrocnemius tendon in six cases, subcutaneous in two cases, in gastrocnemius muscle in two cases. In five of 18 cases (28%), the fluid was far extended to the mid calf. The margin of the rupture site was irregularly lobulated in 12 cases (67%) and acute angle in 12 cases (67%). The septations in the cyst were noted in seven cases (39%). The ruptured fluid sac was continued with main Baker’s cyst except six cases. Associated findings included deep vein thrombosis (n⫽4, 22%) and discoloration of skin overlying the RBC (n⫽3, 17%). Conclusion: Ultrasonography allows well assessment of the features of a ruptured Baker’s cyst. The margin of the RBC was irregularly lobulated and septated, and showed acute angle. Knowledge of these findings of the RBC should allow differential diagnosis and appropriate treatment. 1338 Ultrasonographic Semeiotics of Calcific Tendonitis of the Shoulder: Where Does the Calcium go in the Resorptive Phase? Francesca Lacelli, ASL 2 - Ospedale Santa Corona, Pietra Ligure, Italy Luca M Sconfienza, IRCCS Policlinico San Donato, San Donato Milanese, Italy Alberto Aliprandi, IRCCS Policlinico San Donato, San Donato Milanese, Italy Carmelina Murolo, IST - National Institute for Cancer Research, Genova, Italy Enzo Silvestri, Ospedale Evangelico Internazionale, Genova, Italy Giovanni Serafini, ASL 2 - Ospedale Santa Corona, Pietra Ligure, Italy
Volume 35, Number 8S, 2009 Purpose: The destination of calcium after the spontaneous rupture of tendon calcifications is not exactly understood. The purpose of our work is to describe the appearance of calcifications during the resorptive phase, depicting the most common sites of migration of calcium. Materials and Methods: In a period of 40 months, we treated 815 patients, affected by calcific tendinitis of the shoulder, that were experiencing a hyperalgic pain crisis. Among these, 194 had a broken calcification. We considered as broken those calcifications whose walls were not continuous after the injection of a small amount of saline solution. Then, ultrasound-bursography was performed in all patients to assess the involvement of subacromial-subdeltoid (SASD) bursa. Results: The ultrasound assessment showed a fuzziness of the contour of calcification in 16% of intact calcifications and in 94% of broken calcifications (p⬍0,001), SASD bursitis (75% versus 81%), diffusion of calcium in the SASD bursa and in the sub-bursal space (4% versus 100%, p⬍0,001), inhomogeneous ultrasound appearance of calcification (36% versus 42%) and disappearance of fibrillar echotexture of the tendon involved caused by a diffusion of calcium (26% versus 88%, p⬍0,001). Conclusion: The fuzziness of the contour of calcification, diffusion of calcium in the SASD bursa and in the sub-bursal space and disappearance of fibrillar echotexture of the tendon involved caused by a diffusion of calcium are specific signs of a broken calcification. SASD bursitis and inhomogeneous ultrasound appearance of calcification are non-specific signs. 1339 Pilomatricoma: The Diagnostic Value of Ultrasound Sun Joo Lee, Department of Radiology, College of Medicine, Inje University, Busan Paik Hospital, Korea Hye Jung Choo, Department of Radiology, College of Medicine, Inje University, Busan Paik Hospital, Korea Yeong Mi Park, Department of Radiology, College of Medicine, Inje University, Busan Paik Hospital, Korea Sang Suk Han, Department of Radiology, College of Medicine, Inje University, Busan Paik Hospital, Korea Ji Hwa Ryu, Department of Radiology, College of Medicine, Inje University, Dongrae Paik Hospital, Korea Young Jin Park, Ulsan Boram Hospital, Korea Yong Whan Lee, Department of Radiology, College of Medicine, Daegu Catholic University Medical Center, Korea Jae Huk Lee, Department of Radiology, College of Medicine, Kyungpook National University Hospital, Korea Purpose: The purpose of this study was to analyze statistically significant diagnostic factors for pilomatricoma on the basis of ultrasonic features. Materials and Methods: Sonographic images were retrospectively reviewed from 44 exams with surgically proven pilomatricomas, and from 43 control subjects with other subcutaneous tumors (not including typical lipomas). Two radiologists determined by consensus the tumoral shape, margin, echotexture, echogenicity, posterior shadowing, posterior enhancement, hypoechoic rim, and the presence and pattern of internal calcification and vascularity on color Doppler. Results: The reliable diagnostic factors for pilomatricoma were heterogenicity (P ⬍.001), internal calcification (P ⬍.05), hypoechoic rim (P ⬍.001) and posterior shadowing (P ⬍.001). Scattered dots were most common in the pattern of calcification. A combination of heterogenicity, internal calcification of the scattered dots pattern, and a hypoechoic rim was a statistically significant difference between the two groups (P ⬍.001; odd ratio, 61). Conclusions: The features of heterogeneous echotexture, internal echogenic foci in a scattered dot pattern, and a hypoechoic rim or posterior shadowing itself could be discriminative ultrasonographic
Abstracts criteria for differentiating pilomatricomas from other subcutaneous tumors. 1340 Imaging Findings of Intravascular Papillary Endothelial Hyperplasia Presenting as Soft Tissue Masses in Extremities Sun Joo Lee, Department of Radiology, College of Medicine, Inje University Pusan Paik Hospital, Korea Young Mi Park, Department of Radiology, College of Medicine, Inje University Pusan Paik Hospital, Korea Jae Ryange Juhn, Department of Radiology, College of Medicine, Inje University Pusan Paik Hospital, Korea Choong Ki Eun, Department of Radiology, College of Medicine, Inje University Pusan Paik Hospital, Korea Sung Hwan Hong, Department of Radiology, College of Medicine, Seoul National University Hospital, Korea Ji Young Hwang, Department of Radiology, College of Medicine, Ewha Womans University Mokdong Hospital, Korea In Sook Lee, Department of Radiology, College of Medicine, Pusan National University Hospital, Korea Young Jin Park, Ulsan Boram Hospital, Korea Purpose: To describe the ultrasonography (US) and Magnetic resonance imaging (MRI) findings of IPEH (intravascular papillary endothelial hyperplasia) in extremities. Materials: The six patients were selected during a period of 4 years (from January 2003 through January 2007) from the archives of four institutions. Results: The ultrasonographic findings revealed that pure form occurred most commonly on the finger and hypoechoic soft tissue masses in the subcutis, mixed form were found intramuscularly and showed slightly hyperechoic septum-like structures and central core in the mass corresponding to endothelial papillary proliferative tissue. The papillary endothelial hyperplastic tissues were seen well correlation with hypervascularity on color Doppler US. In the most cases, MRI showed isointense on T1WI and hyperintense on T2WI with enhancement corresponded to the endothelial papillary proliferative tissue in peripheral, septal, and central core. And the hyperintense on T1WI and T2WI were consistent with subacute hemorrhage. Especially in the mixed form of IPEH, The masses looked like a section of an orange on T1WI with gadolinium enhancement due to isointense mass with enhancement in peripheral, septal, and central core. Conclusions: The mixed type of IPEH should be considered as a possible diagnosis when a well defined intramuscular mass showed slightly hyperechoic septum-like structures and central core with hypervascularity on ultrasonography and high signal intensity on T1WI and hyperintense with iso or low signal intensity on T2WI with peripheral, septal and central core enhancement on MRI. The masses looked like a section of an orange on ultrasonography and T1WI with gadolinium enhancement. 1341 Pictorial Essay of Ultrasound Evaluation of Neurogenic Tumors: Head to Toe Asif A Momin, Prince Aly Khan Hospital, Mumbai, India US is first investigation of choice for any palpable lump or bump anywhere in the body. We encountered various such SOL’s during US examinations. The sites include Orbit, Neck in carotid sheath as well as brachial plexus, Post-op nueroma, posterior mediastinal, peripheral extremities, ankle, foot, palmer aspect of hand, abdominal para spinal area,
S193
sub hepatic region, pelvic cavity along the sciatic notch, vaginal wall and even scrotal sac. All these lesion share features like shape, echogenicity, consistency, vascularity and the course of lesion. Some variable findings were recorded. This article will highlight the value of visual impression in the diagnosis of nuerogenic SOL’s even in an unusual locations. 1342 Disgnostic Yield of US-Guided Gun Biopsy in Mulculoskeletal Mass Lesions Myungjin Shin, Asan Medical Center, Korea Heywon Chung, Asan Medical Center, Korea Sanghoon Lee, Asan Medical Center, Korea Shinwoo Lee, Asan Medical Center, Korea Minjung Seo, Asan Medical Center, Korea Minjee Kim, Asan Medical Center, Korea Jinhee Park, Asan Medical Center, Korea Purpose: To evaluate the diagnostic yield of US-guided gun biopsy in various musculoskeletal mass or mass like lesions. Materials and Methods: 47 consecutive cases of US-guided gun biopsy patients were included in this study. The US-guided gun biopsy procedures were performed using 14G, 16G or 18G gun biopsy needle with coaxial technique according to the size and location of the lesion. The number of needle pass was 3 or 4 times and obtained specimens were grossly confirmed. Pathological reports including post-surgical biopsy reports were reviewed to evaluate the diagnostic yield. Results: There was no case of inadequate specimen in pathologic reports. Two cases out of seven malignant tumors (sarcomatous tumors) were not able to determine its subtype. Four out of eight subcutaneous mass or mass-like lesions were reported as non-specific findings. Two cases out of three chondrosarcoma were confirmed as osteosarcoma in post-surgical specimen. Conclusion: Overall diagnostic yield of US-guided gun biopsy in various musculoskeletal mass or mass like lesions is excellent. However, it is good to understand that the specimen from gun biopsy could be difficult in determining the subtype in sarcomatous lesion or differentiating between chondrosarcoma and osteosarcoma or making confirmative pathological diagnosis in subcutaneous lesions. 1343 Usefulness of High Frequency Ultrasonography in Dermatological Examination Elzbieta Szymanska, Department of Dermatology, CSK MSWiA, Poland Magdalena Majsterek, Department of Dermatology, CSK MSWiA, Poland Malgorzata Maj, Department of Dermatology, CSK MSWiA, Poland Wojciech Secomski, Polish Academy of Sciences, Poland Andrzej Nowicki, Polish Academy of Sciences, Poland Lidia Rudnicka, Department of Dermatology, CSK MSWiA, Poland The aim of the study was the assessment of high frequency ultrasonography in dermatologic diagnostics. Examination was performed with 30 MHz ultrasound transducer with 0,1mm resolution and 7mm penetration. We examined patients with neoplasms, cicatrical alopecia, morphea and nail psoriasis. Most of small skin neoplasmatic lesions were hypoechogenic and homogeneous on examination. Extensive lesions were multicomponent with normo, hypo and anechogenic structures. The assessment of lesion’s boarders allows sometimes to conclude the invasiveness of the lesion.
Ultrasound in Medicine and Biology
Methods: Fifty-seven hemiplegic patients (34 men and 23 women) who participated in this study after recent stroke. According to the Brunnstrom motor recovery stage (BMRS), the subjects were divided into poor (BMRS I, II or III) and good (BMRS IV, V or VI) arm motor function groups. Using the sonography to evaluate the hemiplegic shoulder of these 2 groups on admission and before discharge undergoing in-patient rehabilitation. Results: Significant differences were found in proprioception, shoulder spasticity, shoulder subluxation, internal and external rotation of the shoulder, and VAS score of shoulder pain between the poor and good arm motor function groups (all P⬍.05). There was a significant difference in the structural changes of shoulder sonography after rehabilitation between the 2 groups (P⬍.01). Conclusions: Recent stroke patients with flaccid shoulders had significantly poor proprioception, increased muscle tone and shoulder subluxation, restricted internal and external rotation of the shoulders, and higher VAS score. According to the findings on shoulder sonography, we found the patients with poor arm function on admission was tended to have shoulder soft tissue injury during in-patient rehabilitation. 1337 Ruptured Baker’s Cyst: Assessment of Ultrasonographic Findings Soon Tae Kwon, Chungnam Naional University Hospital, Korea Jeong Eun Lee, Chungnam National University Hospital, Korea Young Mo Kim, Chungnam National University Hospital, Korea Purpose: To demonstrate the ultrasonographic (US) imaging features of ruptured Baker’s cyst (RBC). Materials and Methods: US images in 18 patients (12 women, 6 men; age range, 40-67 years; mean age, 55 years) with proven as surgical excision (n⫽5) and needle aspiration (n⫽10), including MR imaging (n⫽10), were enrolled. US imaging was obtained with a routine scan including the axial and longitudinal planes of the popliteal fossa and calf. The extended location and features of the RBC, including any associated findings, were assessed. Results: The ruptured fluid sac was located in the subcrural fascial area in eight cases, between semimembranous and medial gastrocnemius tendon in six cases, subcutaneous in two cases, in gastrocnemius muscle in two cases. In five of 18 cases (28%), the fluid was far extended to the mid calf. The margin of the rupture site was irregularly lobulated in 12 cases (67%) and acute angle in 12 cases (67%). The septations in the cyst were noted in seven cases (39%). The ruptured fluid sac was continued with main Baker’s cyst except six cases. Associated findings included deep vein thrombosis (n⫽4, 22%) and discoloration of skin overlying the RBC (n⫽3, 17%). Conclusion: Ultrasonography allows well assessment of the features of a ruptured Baker’s cyst. The margin of the RBC was irregularly lobulated and septated, and showed acute angle. Knowledge of these findings of the RBC should allow differential diagnosis and appropriate treatment. 1338 Ultrasonographic Semeiotics of Calcific Tendonitis of the Shoulder: Where Does the Calcium go in the Resorptive Phase? Francesca Lacelli, ASL 2 - Ospedale Santa Corona, Pietra Ligure, Italy Luca M Sconfienza, IRCCS Policlinico San Donato, San Donato Milanese, Italy Alberto Aliprandi, IRCCS Policlinico San Donato, San Donato Milanese, Italy Carmelina Murolo, IST - National Institute for Cancer Research, Genova, Italy Enzo Silvestri, Ospedale Evangelico Internazionale, Genova, Italy Giovanni Serafini, ASL 2 - Ospedale Santa Corona, Pietra Ligure, Italy
Volume 35, Number 8S, 2009 Purpose: The destination of calcium after the spontaneous rupture of tendon calcifications is not exactly understood. The purpose of our work is to describe the appearance of calcifications during the resorptive phase, depicting the most common sites of migration of calcium. Materials and Methods: In a period of 40 months, we treated 815 patients, affected by calcific tendinitis of the shoulder, that were experiencing a hyperalgic pain crisis. Among these, 194 had a broken calcification. We considered as broken those calcifications whose walls were not continuous after the injection of a small amount of saline solution. Then, ultrasound-bursography was performed in all patients to assess the involvement of subacromial-subdeltoid (SASD) bursa. Results: The ultrasound assessment showed a fuzziness of the contour of calcification in 16% of intact calcifications and in 94% of broken calcifications (p⬍0,001), SASD bursitis (75% versus 81%), diffusion of calcium in the SASD bursa and in the sub-bursal space (4% versus 100%, p⬍0,001), inhomogeneous ultrasound appearance of calcification (36% versus 42%) and disappearance of fibrillar echotexture of the tendon involved caused by a diffusion of calcium (26% versus 88%, p⬍0,001). Conclusion: The fuzziness of the contour of calcification, diffusion of calcium in the SASD bursa and in the sub-bursal space and disappearance of fibrillar echotexture of the tendon involved caused by a diffusion of calcium are specific signs of a broken calcification. SASD bursitis and inhomogeneous ultrasound appearance of calcification are non-specific signs. 1339 Pilomatricoma: The Diagnostic Value of Ultrasound Sun Joo Lee, Department of Radiology, College of Medicine, Inje University, Busan Paik Hospital, Korea Hye Jung Choo, Department of Radiology, College of Medicine, Inje University, Busan Paik Hospital, Korea Yeong Mi Park, Department of Radiology, College of Medicine, Inje University, Busan Paik Hospital, Korea Sang Suk Han, Department of Radiology, College of Medicine, Inje University, Busan Paik Hospital, Korea Ji Hwa Ryu, Department of Radiology, College of Medicine, Inje University, Dongrae Paik Hospital, Korea Young Jin Park, Ulsan Boram Hospital, Korea Yong Whan Lee, Department of Radiology, College of Medicine, Daegu Catholic University Medical Center, Korea Jae Huk Lee, Department of Radiology, College of Medicine, Kyungpook National University Hospital, Korea Purpose: The purpose of this study was to analyze statistically significant diagnostic factors for pilomatricoma on the basis of ultrasonic features. Materials and Methods: Sonographic images were retrospectively reviewed from 44 exams with surgically proven pilomatricomas, and from 43 control subjects with other subcutaneous tumors (not including typical lipomas). Two radiologists determined by consensus the tumoral shape, margin, echotexture, echogenicity, posterior shadowing, posterior enhancement, hypoechoic rim, and the presence and pattern of internal calcification and vascularity on color Doppler. Results: The reliable diagnostic factors for pilomatricoma were heterogenicity (P ⬍.001), internal calcification (P ⬍.05), hypoechoic rim (P ⬍.001) and posterior shadowing (P ⬍.001). Scattered dots were most common in the pattern of calcification. A combination of heterogenicity, internal calcification of the scattered dots pattern, and a hypoechoic rim was a statistically significant difference between the two groups (P ⬍.001; odd ratio, 61). Conclusions: The features of heterogeneous echotexture, internal echogenic foci in a scattered dot pattern, and a hypoechoic rim or posterior shadowing itself could be discriminative ultrasonographic
Abstracts criteria for differentiating pilomatricomas from other subcutaneous tumors. 1340 Imaging Findings of Intravascular Papillary Endothelial Hyperplasia Presenting as Soft Tissue Masses in Extremities Sun Joo Lee, Department of Radiology, College of Medicine, Inje University Pusan Paik Hospital, Korea Young Mi Park, Department of Radiology, College of Medicine, Inje University Pusan Paik Hospital, Korea Jae Ryange Juhn, Department of Radiology, College of Medicine, Inje University Pusan Paik Hospital, Korea Choong Ki Eun, Department of Radiology, College of Medicine, Inje University Pusan Paik Hospital, Korea Sung Hwan Hong, Department of Radiology, College of Medicine, Seoul National University Hospital, Korea Ji Young Hwang, Department of Radiology, College of Medicine, Ewha Womans University Mokdong Hospital, Korea In Sook Lee, Department of Radiology, College of Medicine, Pusan National University Hospital, Korea Young Jin Park, Ulsan Boram Hospital, Korea Purpose: To describe the ultrasonography (US) and Magnetic resonance imaging (MRI) findings of IPEH (intravascular papillary endothelial hyperplasia) in extremities. Materials: The six patients were selected during a period of 4 years (from January 2003 through January 2007) from the archives of four institutions. Results: The ultrasonographic findings revealed that pure form occurred most commonly on the finger and hypoechoic soft tissue masses in the subcutis, mixed form were found intramuscularly and showed slightly hyperechoic septum-like structures and central core in the mass corresponding to endothelial papillary proliferative tissue. The papillary endothelial hyperplastic tissues were seen well correlation with hypervascularity on color Doppler US. In the most cases, MRI showed isointense on T1WI and hyperintense on T2WI with enhancement corresponded to the endothelial papillary proliferative tissue in peripheral, septal, and central core. And the hyperintense on T1WI and T2WI were consistent with subacute hemorrhage. Especially in the mixed form of IPEH, The masses looked like a section of an orange on T1WI with gadolinium enhancement due to isointense mass with enhancement in peripheral, septal, and central core. Conclusions: The mixed type of IPEH should be considered as a possible diagnosis when a well defined intramuscular mass showed slightly hyperechoic septum-like structures and central core with hypervascularity on ultrasonography and high signal intensity on T1WI and hyperintense with iso or low signal intensity on T2WI with peripheral, septal and central core enhancement on MRI. The masses looked like a section of an orange on ultrasonography and T1WI with gadolinium enhancement. 1341 Pictorial Essay of Ultrasound Evaluation of Neurogenic Tumors: Head to Toe Asif A Momin, Prince Aly Khan Hospital, Mumbai, India US is first investigation of choice for any palpable lump or bump anywhere in the body. We encountered various such SOL’s during US examinations. The sites include Orbit, Neck in carotid sheath as well as brachial plexus, Post-op nueroma, posterior mediastinal, peripheral extremities, ankle, foot, palmer aspect of hand, abdominal para spinal area,
S193
sub hepatic region, pelvic cavity along the sciatic notch, vaginal wall and even scrotal sac. All these lesion share features like shape, echogenicity, consistency, vascularity and the course of lesion. Some variable findings were recorded. This article will highlight the value of visual impression in the diagnosis of nuerogenic SOL’s even in an unusual locations. 1342 Disgnostic Yield of US-Guided Gun Biopsy in Mulculoskeletal Mass Lesions Myungjin Shin, Asan Medical Center, Korea Heywon Chung, Asan Medical Center, Korea Sanghoon Lee, Asan Medical Center, Korea Shinwoo Lee, Asan Medical Center, Korea Minjung Seo, Asan Medical Center, Korea Minjee Kim, Asan Medical Center, Korea Jinhee Park, Asan Medical Center, Korea Purpose: To evaluate the diagnostic yield of US-guided gun biopsy in various musculoskeletal mass or mass like lesions. Materials and Methods: 47 consecutive cases of US-guided gun biopsy patients were included in this study. The US-guided gun biopsy procedures were performed using 14G, 16G or 18G gun biopsy needle with coaxial technique according to the size and location of the lesion. The number of needle pass was 3 or 4 times and obtained specimens were grossly confirmed. Pathological reports including post-surgical biopsy reports were reviewed to evaluate the diagnostic yield. Results: There was no case of inadequate specimen in pathologic reports. Two cases out of seven malignant tumors (sarcomatous tumors) were not able to determine its subtype. Four out of eight subcutaneous mass or mass-like lesions were reported as non-specific findings. Two cases out of three chondrosarcoma were confirmed as osteosarcoma in post-surgical specimen. Conclusion: Overall diagnostic yield of US-guided gun biopsy in various musculoskeletal mass or mass like lesions is excellent. However, it is good to understand that the specimen from gun biopsy could be difficult in determining the subtype in sarcomatous lesion or differentiating between chondrosarcoma and osteosarcoma or making confirmative pathological diagnosis in subcutaneous lesions. 1343 Usefulness of High Frequency Ultrasonography in Dermatological Examination Elzbieta Szymanska, Department of Dermatology, CSK MSWiA, Poland Magdalena Majsterek, Department of Dermatology, CSK MSWiA, Poland Malgorzata Maj, Department of Dermatology, CSK MSWiA, Poland Wojciech Secomski, Polish Academy of Sciences, Poland Andrzej Nowicki, Polish Academy of Sciences, Poland Lidia Rudnicka, Department of Dermatology, CSK MSWiA, Poland The aim of the study was the assessment of high frequency ultrasonography in dermatologic diagnostics. Examination was performed with 30 MHz ultrasound transducer with 0,1mm resolution and 7mm penetration. We examined patients with neoplasms, cicatrical alopecia, morphea and nail psoriasis. Most of small skin neoplasmatic lesions were hypoechogenic and homogeneous on examination. Extensive lesions were multicomponent with normo, hypo and anechogenic structures. The assessment of lesion’s boarders allows sometimes to conclude the invasiveness of the lesion.