3.Discussion
Xanthomatosis of the skin is a group of diseases characterized by yellow
patches, papules, or nodules, accompanied by increased lipids and other
organ abnormalities. 8 Due to the accumulation of
lipid-containing cells in the skin dermis, yellow nodular lesions often
form on the skin surface. 9 The rash forms and
distribution of this disease vary, and there are mainly 4 types:
nodular, flat, rash and tendinous.10 This disease can be associated with abnormal lipid
metabolism. Some cases have familial or systemic lesions. For example,
lipid deposition in the cardiovascular system that can produce
arteriosclerosis and embolism of small vessels. 11,12
There were few literature reports about ultrasonic findings of
multiple tubercular xanthomas on
bilateral buttocks with
hypercholesterolemia. 13,14And most of them is all
about ultrasonic findings of achilles tendon xanthoma.15,16However, this case report is about ultrasonic
characteristic manifestations of multiple tubercular xanthomas on
bilateral buttocks with hypercholesterolemia. Ultrasound can find the
size, depth, layer of skin involved and blood supply of lesion,
providing vital help for surgical options.
More importantly, Sonographic appearance had certain characteristics in
this case. There were several hyperechoic masses in the skin dermis of
bilateral buttocks, and the
biggest was on the left buttock, with clear boundary and irregular
shape. Abundant blood flow signals could be detected within the masses.
Low-velocity, low-obstruction arterial and low-velocity venous blood
flow spectra were detected, which
might be a characteristic performance in diagnosing this rare case.
Appearance of blood signal may indicate foam cell activity. Further
study with a large sample size is needed to confirm it. Moreover, the
uneven internal echo was meshed, which might be related to the nodular
distribution of foam cells.
Therefore, the ultrasonic characteristic findings contained uneven
meshed internal echo and abundant
blood flow signals within the masses, with low-obstruction arterial and
low-velocity venous blood flow spectra. They can help to differentiate
xanthomas from other diseases such as skin keloid in which blood flow
signals cannot be detected. Due to the rarity of xanthomas at this site,
the experience of ultrasonic examination still needs to be accumulated
in future case study.