Ultrasonography of skin changes in legs with chronic venous disease

Background: In daily practice, ultrasonography (US) is used only to designate the location and pattern of venouslesions. Skin US is not performed between routine venous investigations.Methods: Skin morphology is evaluated by the same probes used for routine Duplex evaluation of superficialveins. US findings from evident skin lesions are comparatively evaluated with those from the surroundingapparently normal skin and from the contralateral leg.Results: Inflammation and dermal edema can be found in the apparently normal skin of C2 legs. Swollen legsshow thickening of the subcutaneous layer as a result of diffuse soaking or anechoic cavities, with or withoutdermal edema. Chronic hypodermitis is characterized by inflammatory edema in initial phases, and byliposclerosis in advanced cases. Recrudescence of inflammation provokes focal rarefactions of the subcutaneouslayer, possibly related to ulcer opening.Conclusion: In legs with venous disorders, sonography refines clinical evaluation of the skin and may revealchanges not highlighted by inspection. Some of these changes could require further investigation because theyhave not yet been explained or described. Skin sonography should improve knowledge of the natural history ofskin changes, as well as contribute to a better grading of venous diseases severity In particular, US evidence ofcutaneous and subcutaneous changes in C2 legs should be considered to stratify the treatment in C2 legs, byidentifying those in which varicose veins are not simply a cosmetic problem.