Introduction
The diagnosis of lipoedema, is based on clinical examination, however, the three-dimensional ultrasound is very useful in providing tissue information as well as lymphoscintigraphy exam for the evaluation of transit of the radiotracer.
Aims of study
It was decided to apply three ultrasound diagnostics in the evaluation of structural assessment of adipo-fascia, having a view on three planes of space with possible processing of image with suitable software, and to assess the requested lymphoscintigraphy exam in order to explain some ultrasound features in different clinical stages.
Methods
The tissue evaluation was performed using an adequate instrument (SonoScape 20 - probe 17 MHz) through longitudinal-transversal scans on constant bilateral symmetric marker points in non obese females with lipoedema, aged 18-55 years, (30 stage 1, 40 stage 2,
25 stage 3 - all type III). Venous or lymphatic involvement (physical examination-duplex ultrasound evaluation) was not present in any of the patients. Furthermore lymphoscintigraphy exam was required (subcutaneous injection with 99mTc-Nanocoll®).
Results
In all clinical stages, three ultrasound diagnostics highlighted a normal ultrasound representation of the epidermis-dermis complex as well as the increased thickness of the subcutaneous tissue, due to hypertrophy of the adipose lobules not adherent to each other but separated by thickened connective septa, both more marked in stage 2 and stage 3. In addition, in view of the presence of increased anechogenicity due to fluid, along the superficial fascial path, as well as the deep one too, the author carried out an experimental study, awaiting publication, that has showed that the fluid is bound to the fascia and not free. Furthermore, in the stage 2 and stage 3 the lobules, in a non-homogeneous way, show an increased anechogenicity, which according to the author, it is partly due to free fluid, but also linked to glycosaminoglycans in gel phase; also in the septa, the presence of an increased anechogenicity due to fluid was noted, reabsorbed and removed by pre-collectors, albeit slowly in consideration of the slow lymphatic flow highlighted by lymphoscintigraphy exam.
Conclusions
High-quality three ultrasound diagnostics resulted in being considerably useful in the evaluation of lipoedema tissue, because it provides important structural details of adipo-fascia, while lymphoscintigraphy exam could explain some ultrasound features in the stage 2 and stage 3.