Ximena Wortsman1, Ariel Castro2, Andres Figueroa3. 1. Departments of Radiology and Dermatology, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Clinica Servet, Faculty of Medicine, University of Chile, Santiago, Chile. Electronic address: xworts@yahoo.com. 2. Office for Clinical Research Support, Hospital Clinico Universidad de Chile, Faculty of Medicine, University of Chile, Santiago, Chile. 3. Department of Dermatology, Hospital Clinico Universidad de Chile, Faculty of Medicine, University of Chile, Santiago, Chile.
Abstract
BACKGROUND: Fistulous tracts in hidradenitis suppurativa (HS) are key signs of severity and their clinical evaluation alone may be limited for assessing their presence and morphology. There is also a need to determine the factors that allow reversibility of the anatomic changes in HS. OBJECTIVE: We sought to categorize fistulous tracts in HS. METHODS: A retrospective study of color Doppler ultrasound images of cases with positive clinical and sonographic criteria of HS with fistulous tracts was performed. The sonographic staging of HS, location, and anatomic characteristics of the tracts were registered and graded. Statistical analysis for correlating variables was performed using bivariate and multivariate studies. RESULTS: In all, 52 patients presenting 96 fistulous tracts met the criteria. Morphology was defined and a sonographic classification into 3 types of fistulae was developed. Type 3 concentrated 71% of the cases presenting communicating tracts, and type 2, 29%. Types 2 and 3 represented 63% of patients with multiple fistulous tracts. Fistulous tracts types 2 and 3 were significantly correlated with age 35 years or older and groin location. LIMITATIONS: Ultrasound cannot detect lesions less than 0.1 mm. CONCLUSION: Fistulous tracts in HS can be categorized using ultrasound, which may support earlier and more precise management.
BACKGROUND: Fistulous tracts in hidradenitis suppurativa (HS) are key signs of severity and their clinical evaluation alone may be limited for assessing their presence and morphology. There is also a need to determine the factors that allow reversibility of the anatomic changes in HS. OBJECTIVE: We sought to categorize fistulous tracts in HS. METHODS: A retrospective study of color Doppler ultrasound images of cases with positive clinical and sonographic criteria of HS with fistulous tracts was performed. The sonographic staging of HS, location, and anatomic characteristics of the tracts were registered and graded. Statistical analysis for correlating variables was performed using bivariate and multivariate studies. RESULTS: In all, 52 patients presenting 96 fistulous tracts met the criteria. Morphology was defined and a sonographic classification into 3 types of fistulae was developed. Type 3 concentrated 71% of the cases presenting communicating tracts, and type 2, 29%. Types 2 and 3 represented 63% of patients with multiple fistulous tracts. Fistulous tracts types 2 and 3 were significantly correlated with age 35 years or older and groin location. LIMITATIONS: Ultrasound cannot detect lesions less than 0.1 mm. CONCLUSION: Fistulous tracts in HS can be categorized using ultrasound, which may support earlier and more precise management.