‘Dot in circle sign’: a characteristic finding in ultrasound and MR imaging of soft tissue mycetomas
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چکیده
To cite: Neelakantan S, Babu AAS, Anandarajan R. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2016-216502 DESCRIPTION A 36-year-old man presented with a history of painless swelling on his right distal foot progressively increasing in size since 2 years. Physical examination revealed a non-pulsatile, non-tender, firm swelling over the medial aspect of distal right foot. No discharging sinuses were noted. Plain radiograph showed normal underlying bones with soft tissue swelling of the medial aspect of the right distal foot (figure 1). Ultrasound examination showed multiple, conglomerate hypoechoic lesions with a hyperechoic centre with diffusely increased Doppler signal pick up within (figure 2). MRI revealed hypointense intralesional signals on T1-weighted images and hyperintense intralesional signals on T2-weighted and short tau inversion recovery (STIR) images, involving the subcutaneous and muscular planes of the dorsal and plantar aspects of the medial aspect of the right distal foot. Also noted were multiple, conglomerate, spherical T2 and STIR hyperintense intralesional foci, with hypointense rims, few of which also showed a central hypointensity (Dot in circle sign). The underlying bone appeared normal (figures 3 and 4). On the basis of clinical presentation, examination and imaging features a diagnosis of mycetoma foot was made and confirmed with punch biopsy and histopathological analysis, which revealed filamentous fungal grains with amorphous brown matrix, suggestive of Madurella mycetomatis. The patient was started on itraconazole therapy for 12 months and showed significant resolution of the swelling on follow-up clinical evaluation at 9 months. Mycetoma foot is a chronic granulomatous disease of the subcutaneous tissue native to the tropics. It was first reported in Madurai district of
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عنوان ژورنال:
دوره 2016 شماره
صفحات -
تاریخ انتشار 2016