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www.actasdermo.org

Ecografía aplicada al manejo de la patología de la uña D. Vidala,*, B. Echeverriab, J. García-Gavínc,d y L. Comba Pérez-Pérezc,d Servicio de Dermatología, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, España

a

Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España

b

Estructura Organizativa de Xestión Integrada de Vigo, Vigo, Pontevedra, España

c

Clínica Pérez & Gavín Dermatólogos, Vigo, Pontevedra, España

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Ultrasound in the management of nail disease KEYWORDS +LJKIUHTXHQF\ XOWUDVRXQG &RORXU'RSSOHU 1DLOSVRULDVLV 1DLOWXPRXU

Abstract  1DLOGLVHDVHVDUHDGLDJQRVWLFFKDOOHQJHDQGKLJKIUHTXHQF\XOWUDVRXQGZLWKFRORXU 'RSSOHULVDVLPSOHDQGSDLQOHVVGLDJQRVWLFWHVWWKDWFDQRIWHQEHXVHIXO8OWUDVRXQGDOORZVUHDO WLPHHYDOXDWLRQRIWKHDQDWRPLFDOVWUXFWXUHVRIWKHQDLODQGLWVYDVFXODULVDWLRQ7KHSUHVHQW VWXG\UHYLHZVWKHOLWHUDWXUHRQXOWUDVRXQGÀQGLQJVLQWKHQRUPDOQDLODQGLQLQÁDPPDWRU\DQG WXPRXUDOGLVHDVH ‹(OVHYLHU(VSDxD6/8DQG$('9$OOULJKWVUHVHUYHG

Ecografía del aparato ungueal normal Estructura anatómica (ODSDUDWRXQJXHDOHVXQDSpQGLFHFXWiQHRFRPSOHMRFRQVWLWXLGRSRU ‡ 0DWUL]XQJXHDO6HWUDWDGHXQHSLWHOLRTXHTXHUDWLQL]DVLQ ODIRUPDFLyQGHOHVWUDWRJUDQXORVR\TXHVHHQFXHQWUD MXVWRSRUGHEDMRGHODSDUWHSUR[LPDOGHODOiPLQDXQ-

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0001-7310/© 2015 Elsevier España, S.L.U. y AEDV. Todos los derechos reservados.

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Ecografía ungueal en otras enfermedades inÁamatorias Alopecia areata (QODDORSHFLDDUHDWDHVIUHFXHQWHODDIHFWDFLyQGHODXxDGHO DOGHORVSDFLHQWHV /DPDQLIHVWDFLyQPiVIUHFXHQWH HVHOSLTXHWHDGRPiVGHXQ VHJXLGRGHODWUDTXLRQLTXLD (OHULWHPDSHULXQJXHDOVHKDSURSXHVWRFRPRPDQLIHVWDFLyQ GHHQIHUPHGDGDJXGD/DVPDQLIHVWDFLRQHVSXHGHQSDUHFHUVHDODVGHODSVRULDVLVXQJXHDO/RVKDOOD]JRVHFRJUiÀFRVVRQ KLSHUHFRJHQLFLGDGHQJURVDPLHQWR\RQGXODFLyQGHODOiPLQD XQJXHDOLQFUHPHQWRGHODFRQFDYLGDG\DGHPiVVHHYLGHQFLD GLVPLQXFLyQGHODYDVFXODUL]DFLyQGHOOHFKRORTXHSXHGHVHU ~WLOSDUDHOGLDJQyVWLFRGLIHUHQFLDOFRQSVRULDVLV Conectivopatías /DHFRJUDItDFRQ'RSSOHUFRORUVHKDHPSOHDGRFRPRDOWHUQDWLYDRFRPSOHPHQWRDODFDSLODURVFRSLDHQODYDORUDFLyQ GHOÁXMRYDVFXODUGHORVFDSLODUHVSHULXQJXHDOHV\VXEXQJXHDOHV+DGHPRVWUDGRXWLOLGDGSDUDGLIHUHQFLDUHQWUHIHQyPHQR GH5D\QDXGSULPDULR\VHFXQGDULRDOGHWHFWDUDQRPDOtDVHQ ODPLFURFLUFXODFLyQFRQPiVSUHFLVLyQTXHODFDSLODURVFRSLD 7DPELpQVHKDXWLOL]DGRSDUDHOHVWXGLRGHDQRPDOtDVPLFURYDVFXODUHVHQSDFLHQWHVFRQHQIHUPHGDGLQGLIHUHQFLDGDGHO WHMLGRFRQHFWLYR\HVFOHURVLVVLVWpPLFD $GHPiVVHKDQGHVFULWRKDOOD]JRVHFRJUiÀFRVHQHVFOHURGHUPLDGHUPDWRPLRVLWLV\OXSXVHULWHPDWRVRVLVWpPLFR/RVKDOOD]JRVHFRJUiÀFRVHQODHVFOHURVLVVLVWpPLFDVRQYDULDEOHV6H KDGHVFULWRXQLQFUHPHQWRGHODFRQFDYLGDGHQJURVDPLHQWR\ GLVPLQXFLyQGHODHFRJHQLFLGDGGHOOHFKRXQJXHDO7DPELpQVH HYLGHQFLDGLVPLQXFLyQGHOÁXMRYDVFXODUSUREDEOHPHQWHGHELGRDOHQOHQWHFLPLHQWRGHODFLUFXODFLyQORTXHKDFHTXHQR VHDWHFQROyJLFDPHQWHSRVLEOHHYLGHQFLDUODFRQORVGLVSRVLWLYRV DFWXDOHV(QODFDOFLQRVLVDVRFLDGDDGHUPDWRPLRVLWLVFRQOD HFRJUDItDSXHGHQDSUHFLDUVHGHSyVLWRVSHULXQJXHDOHVGHFDOFLRTXHQRUPDOPHQWHVHORFDOL]DQHQODSXQWDGHORVGHGRV\ VHHYLGHQFLDQFRPRIRFRVKLSHUHFRLFRVFRQVRPEUDDF~VWLFD SRVWHULRU(QRFDVLRQHVHVWHKDOOD]JRVHDFRPSDxDGHKLSRHFRJHQLFLGDGGHODGHUPLVVXSUD\DFHQWHSUREDEOHPHQWH SRUHOHGHPDSURGXFLGR6HSXHGHHYLGHQFLDUWDPELpQLQFUHPHQWRGHODYDVFXODUL]DFLyQGHOOHFKR/DDIHFWDFLyQXQJXHDO GHOOXSXVHULWHPDWRVRVLVWpPLFRVHHYLGHQFLDFRPRXQLQFUHPHQWRGHOJURVRUGHODOiPLQDXQJXHDO\GHODPDWUL]\OHFKR XQJXHDODVtFRPRXQDGLVPLQXFLyQGHODYDVFXODUL]DFLyQGHO OHFKRXQJXHDO Otras enfermedades inÁamatorias 6HKDQSXEOLFDGRORVKDOOD]JRVHFRJUiÀFRVGHODXxDHQOD UHWURQLTXLD\RQLFRPDGHVLVLFWLRVLVDXWRVyPLFDUHFHVLYD OLQIHGHPDFUyQLFRGHODVSLHUQDVHQJURVDPLHQWRGHODPDWUL] ItVWXODVVXEXQJXHDOHV\ÀEURVLVTXtVWLFD(QHVWD ~OWLPDVHREVHUYDXQLQFUHPHQWRGHODFRQFDYLGDG\HQJURVDPLHQWRGHODOiPLQDXQJXHDOFRQLQFUHPHQWRGHODYDVFXODUL]DFLyQGHOOHFKRXQJXHDOHVSHFLDOPHQWHVXSRUFLyQ SUR[LPDO



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Tumores del aparato ungueal /RVWXPRUHVGHODXxDWLHQHQPDQLIHVWDFLRQHVFOtQLFDVSRFR HVSHFtÀFDV\HVGLItFLOHVWDEOHFHUVXWDPDxR\ORFDOL]DFLyQ H[DFWDSRUORTXHODVWpFQLFDVGHLPDJHQVRQGHJUDQD\XGD SDUDGLDJQRVWLFDU\ORFDOL]DUHVWRVWXPRUHV/DPLFURVFRSLD FRQIRFDO\ODWRPRJUDItDySWLFDGHFRKHUHQFLDWLHQHQSRFD SHQHWUDFLyQORTXHGLÀFXOWDYDORUDUODOHVLyQHQVXWRWDOLGDG DVtFRPRVXORFDOL]DFLyQH[DFWD\UHODFLRQHV/DUHVRQDQFLD PDJQpWLFDRIUHFHSRFDUHVROXFLyQHQOHVLRQHVPHQRUHVGH PP\QRSHUPLWHYDORUDUHOÁXMRVDQJXtQHRHQWLHPSRUHDO 3RUHOFRQWUDULRODHFRJUDItDGHDOWDIUHFXHQFLDFRQ'RSSOHU FRORURIUHFHEXHQDUHVROXFLyQHQOHVLRQHVSHTXHxDV\SHUPLWHHYDOXDUODYDVFXODUL]DFLyQSRUORTXHHVODPHMRUWpFQLFD GHLPDJHQHQHOGLDJQyVWLFRGHHVWRVWXPRUHV$FRQWLQXDFLyQVHGHVFULEHQODVFDUDFWHUtVWLFDVHFRJUiÀFDVGHORVWXPRUHVGHODSDUDWRXQJXHDO

Verruga subungueal

Queratoacantoma ,PDJHQELHQFLUFXQVFULWDFRQHFRJHQLFLGDGPL[WDKLSRHFRLFD \DQHFRLFD UHPRGHODFLyQFRUWLFDOHURVLyQGHORVPiUJHQHV yVHRV\SUHVHQFLDGHUHIXHU]RDF~VWLFRSRVWHULRU

Onicomatricoma ,PDJHQKLSHUHFRLFDH[FpQWULFDHQODPDWUL]\HOOHFKRXQJXHDO 3XHGHSUHVHQWDUHQVXLQWHULRUSXQWRVOLQHDOHVKLSHUHFRLFRV6H KDGHVFULWRUHPRGHODFLyQRFDPELRVHURVLYRVHQHOPDUJHQyVHR KLSHUYDVFXODULGDG\H[SDQVLyQGHOSOLHJXHXQJXHDOSUR[LPDO

Fibromas ,PDJHQXQLIRUPHKLSRHFRLFDQRGXODUXRYDOHQHOOHFKRGHOD XxDTXHSXHGHDIHFWDUDODPDWUL]/RVWXPRUHVGHJUDQWDPDxRSXHGHQWHQHUUHPRGHODFLyQGHOPDUJHQyVHR6RQJH-

Figura 3

Exostosis subungueal ,PDJHQOLQHDOKLSHUHFRLFDÀJ FRQVRPEUDDF~VWLFDSRVWHULRUTXHFRQHFWDFRQODOtQHDKLSHUHFRLFDGHOPDUJHQyVHR GHODIDODQJHGLVWDO1RUPDOPHQWHGHVSOD]DODOiPLQDKDFLD DUULED\KD\DXVHQFLDGHYDVFXODUL]DFLyQ(QODSHULIHULDGH ODVH[RVWRVLVVHSXHGHYHUWHMLGRKLSRHFRLFRPDOGHÀQLGR UHVXOWDGRGHODUHDFFLyQLQÁDPDWRULD\FLFDWUL]DFLyQVHFXQGDULD

Osteocondroma subungueal ,PDJHQUHGRQGHDGDELHQGHÀQLGDKLSRHFRLFDFRQLQFUHPHQWRGHODYDVFXODUL]DFLyQ

Quiste mixoide sinovial

,PDJHQKLSRHFRLFDJHQHUDOPHQWHGHIRUPDIXVLIRUPHRQRGXODU6HDVRFLDDXQHQJURVDPLHQWRGHODVWDEODVYHQWUDO\ GRUVDOGHODOiPLQDXQJXHDOFRQLQFUHPHQWRGHOHVSDFLRHQWUH DPEDV1RUPDOPHQWHQRSUHVHQWDYDVFXODUL]DFLyQVDOYRODV ORFDOL]DGDVHQHOKLSRQLTXLRTXHSXHGHQSUHVHQWDUXQLQFUHPHQWRGHOÁXMRGpUPLFRVXE\DFHQWH

A

QHUDOPHQWHKLSRYDVFXODUHVFRQH[FHSFLyQGHODQJLRÀEURPD TXHVHSXHGHSUHVHQWDUFRQSHTXHxRVYDVRVFRQÁXMRYHQRVR RDUWHULDOGHEDMDYHORFLGDG

,PDJHQKLSRHFRLFDRDQHFRLFDRYDODGDRUHGRQGHDGDFRQ UHIXHU]RDF~VWLFRSRVWHULRU\DXVHQFLDGHÁXMRVDQJXtQHR(Q RFDVLRQHVVHREVHUYDXQWUDFWRWRUWXRVRDQHFRLFRTXHFRPXQLFDODOHVLyQFRQODDUWLFXODFLyQLQWHUIDOiQJLFDGLVWDO6H SXHGHREVHUYDUHQJURVDPLHQWRLUUHJXODULGDG\GHVSOD]DPLHQWRGHODSODFDXQJXHDOHQHOPLVPRHMHGHODFRPSUHVLyQ XQJXHDO

Granuloma piogénico ,PDJHQPDOGHÀQLGDKLSRHFRLFDHQHOOHFKRXQJXHDO8QDR DPEDVOiPLQDVGHODWDEODVHSXHGHQHQJURVDU\XRQGXODU 6HSXHGHGHWHFWDUJUDGRVYDULDEOHVGHÁXMRVDQJXtQHRHQVX LQWHULRUGHVGHKLSRDKLSHUYDVFXODUL]DFLyQFRQÁXMRDUWHULDO 

Tumor glómico ,PDJHQQRGXODUKLSRHFRLFDVLWXDGDHQHOOHFKRXQJXHDOFRQ DXPHQWRGHODYDVFXODUL]DFLyQ6HGHWHFWDÁXMRVDQJXtQHR DUWHULDOLQWUDWXPRUDOFRQYHORFLGDGVLVWyOLFDPi[LPDHQWUH \FPV(VFRP~QYHUUHPRGHODFLyQGHOPDUJHQyVHR GHODIDODQJHGLVWDOSRUGHEDMRGHOWXPRUORTXHUHÁHMDHO FUHFLPLHQWROHQWRGHOWXPRU

B

([yVWRVLVVXEXQJXHDO(FRJUDItDGHODH[yVWRVLVVXEXQJXHDO&RUWHORQJLWXGLQDOFRQVRQGDGH0+]

(FRJUDItDDSOLFDGDDOPDQHMRGHODSDWRORJtDGHODXxD

Perineuroma ,PDJHQPDOGHÀQLGDH[FpQWULFDKLSRHFRLFDHQODPDWUL]\ HOSOLHJXHXQJXHDOLSVLODWHUDO(O'RSSOHUPXHVWUDKLSHUYDVFXODUL]DFLyQ

Hematoma y absceso subungueal ,PiJHQHVPDOGHÀQLGDVDQHFRLFDVHQHOOHFKRXQJXHDOTXH SXHGHQFRQWHQHUVHSWRVKLSHUHFRLFRVHQHOLQWHULRU

Hemangioma subungueal ,PDJHQKLSRHFRLFDHVFDVDPHQWHGHÀQLGDFRQLQFUHPHQWR GHODYDVFXODUL]DFLyQ(QVXLQWHULRUSXHGHQYHUVHLPiJHQHV KLSHUHFRLFDVFRQVRPEUDDF~VWLFDSRVWHULRUTXHFRUUHVSRQGHQ DÁHEROLWRV

Lesiones granulomatosas ,PDJHQKLSRHFRLFDHQHOOHFKRXQJXHDOTXHGHVSOD]DODOiPLQDXQJXHDO9DVFXODUL]DFLyQYDULDEOHGHVGHHVFDVDDDEXQGDQWH

Epitelioma espinocelular y melanoma ,PiJHQHVKLSRHFRLFDVFRQLQFUHPHQWRGHODYDVFXODUL]DFLyQ /DVLPiJHQHVQRVRQHVSHFtÀFDVSHURODHFRJUDItDHV~WLOHQ ODORFDOL]DFLyQGHHVWDVSHUPLWLHQGRYDORUDUVXWDPDxR\ UHODFLRQHVFRQHVWUXFWXUDVDG\DFHQWHVD\XGDQGRSRUWDQWR DSODQLÀFDUODFLUXJtD

Conclusión /DHFRJUDItDGHDOWDIUHFXHQFLDFRQ'RSSOHUFRORUHVXQD SUXHEDVHQFLOODHLQGRORUDTXHKDGHPRVWUDGRVHU~WLOHQHO GLDJQyVWLFR\VHJXLPLHQWRGHPXFKDVHQIHUPHGDGHVGHODV XxDV$PHGLGDTXHODHFRJUDItDVHLQFRUSRUHDODSUiFWLFD FOtQLFDKDELWXDOGHOGHUPDWyORJRVHLUiQGHVFULELHQGRQXHYRV KDOOD]JRVHFRJUiÀFRVTXHFRQÀUPDUiQVXXWLOLGDGHQODSDWRORJtDXQJXHDO

ConÁicto de intereses /RVDXWRUHVGHFODUDQQRWHQHUQLQJ~QFRQÁLFWRGHLQWHUHVHV

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