Cutaneous, Subcutaneous, and Bilateral Adrenal Gland Metastases in Progressive Prostate Carcinoma: Theranostic Potential of 68 Ga-PSMA-11 PET/CT Imaging and 177 Lu-PSMA-617 Therapy.

ABSTRACT: Prostate carcinoma (PC) is the second most common malignant tumor in males globally. The metastatic spread of PC usually involves the pelvic and abdominal lymph nodes and the skeletal system. Cutaneous metastases are exceedingly uncommon and typically manifest themselves late in the disease course, considered as ominous sign with limited treatment options and a poor prognosis. We describe a patient wherein 68 Ga-PSMA-11 PET/CT detected multiple uncommon metastatic sites in the cutaneous region of the scrotum, penis, and thigh, as well as in the subcutaneous region of anterior abdominal wall, and in bilateral adrenal glands. These findings served as a theranostic tool for selecting 177 Lu-PSMA-617 treatment for these extremely rare metastatic sites.

Ultrasound Detected Subcutaneous Changes in a Pediatric Cohort After Initiation of a New Insulin Pump or Glucose Sensor.

Objective: This study examined subcutaneous tissue changes at sites used by continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM), and tested whether these changes, if any, were associated with glycated hemoglobin (HbA1c). Research Design and Methods: This prospective study investigated recently used CSII or CGM sites in 161 children and adolescents during the first year after initiation of a new diabetes device. Subcutaneous changes such as echogenicity, vascularization, and the distance from the skin surface to the muscle at CSII and CGM sites were assessed by ultrasound. Results: The distance from skin surface to muscle fascia at both the upper arm and abdomen was influenced by age, body mass index z-score, and sex. Especially in boys and the youngest, the depth of many devices outreached the mean distance. The mean distance for boys at the abdomen and upper arm ranged from 4.5-6.5 mm and 5-6.9 mm for all ages, respectively. Hyperechogenicity at CGM sites was 4.3% after 12 months. The frequency of subcutaneous hyperechogenicity and vascularization at CSII sites increased significantly over time (41.2% to 69.3% and 2% to 16% respectively, P < 0.001 and P = 0.009). Hyperechogenicity in the subcutis was not a predictor of elevated HbA1c (P = 0.11). Conclusion: There is large variation in the distance from the skin surface to the muscle fascia and many diabetes devices reach even deeper. Hyperechogenicity and vascularization increased significantly over time at CSII sites, but not CGM sites. The importance of hyperechogenicity for insulin absorption is unclear and further investigations are needed. Clinical Trial Registration number: NCT04258904.

Voltage gradients in transvenous and subcutaneous defibrillation and their risk of myocardial damage.

INTRODUCTION: Transvenous implantable cardioverter-defibrillator (ICD) shocks have been associated with cardiac biomarker elevations and are thought in some cases to contribute to adverse clinical outcomes and mortality, possibly from myocardium exposed to excessive shock voltage gradients. Currently, there are only limited data for comparison with subcutaneous ICDs. We sought to compare ventricular myocardium voltage gradients resulting from transvenous (TV) and subcutaneous defibrillator (S-ICD) shocks to assess their risk of myocardial damage. METHODS: A finite element model was derived from thoracic magnetic resonance imaging (MRI). Voltage gradients were modeled for an S-ICD with a left-sided parasternal coil and a left-sided TV-ICD with a mid-cavity, a septal right ventricle (RV) coil, or a dual coil lead (TV mid, TV septal, TV septal + superior vena cava [SVC]). High gradients were defined as > 100 V/cm. RESULTS: The volumes of ventricular myocardium with high gradients > 100 V/cm were 0.02, 2.4, 7.7, and 0 cc for TV mid, TV septal, TV septal + SVC, and S-ICD, respectively. CONCLUSION: Our models suggest that S-ICD shocks produce more uniform gradients in the myocardium, with less exposure to potentially damaging electrical fields, compared to TV-ICDs. Dual coil TV leads yield higher gradients, as does closer proximity of the shock coil to the myocardium.

An Exploration of the Anatomy of the Forehead of Asians and Its Relationship With Forehead Lines Based on Ultrasound Imaging.

BACKGROUND: A profound understanding of the various frontal tissues' morphology and their relationship with forehead lines can efficiently guide clinical treatment. OBJECTIVES: The authors explored the relationship between frontal anatomy and frontal lines. METHODS: We measured the thickness and shape of tissues in different regions of the forehead of 241 Asians. Then, we analyzed the relationship between the types of frontalis muscle and frontal lines, as well as the relationship between the frontal anatomical structures and the production of frontal lines. RESULTS: We classified the types of frontalis muscle into 3 categories comprising 10 subtypes. The skin (0.78 mm vs 0.90 mm, P < .05), superficial subcutaneous tissue (0.66 mm vs 0.75 mm, P < .05), and frontalis muscle thickness (0.29 mm vs 0.37 mm, P < .05) of people with obvious dynamic forehead lines were significantly thicker than those of people without significant dynamic forehead lines. However, no significant difference in the deep subcutaneous tissue thickness was found between people with and without static forehead lines (1.36 mm vs 1.34 mm, P < .05). CONCLUSIONS: This study shows the relationship between the frontal structure and frontal lines. Therefore, these results can provide references for treating frontal lines, to a certain extent.

Exploring Indicators of Subcutaneous Tissue Fluid Accumulation in Breast Cancer-Related Lymphedema Patients Using Fractal Analysis with Virtual Volume.

Background: Breast cancer treatment sometimes causes a chronic swelling of the arm called breast cancer-related lymphedema (BCRL). Its progression is believed to be irreversible and is accompanied by tissue fibrosis and lipidosis, so preventing lymphedema from progressing by appropriate intervention at the site of fluid accumulation at an early stage is crucial. The tissue structure can be evaluated in real time by ultrasonography, and this study aims at assessing the ability of fractal analysis using virtual volume in detecting fluid accumulation within BCRL subcutaneous tissue via ultrasound imaging. Methods and Results: We worked with 21 women who developed BCRL (International Society of Lymphology stage II) after unilateral breast cancer treatment. Their subcutaneous tissues were scanned with an ultrasound system (Sonosite Edge II; Sonosite, Inc., FUJIFILM) using a 6- to 15-MHz linear transducer. Then, a 3-Tesla MR system was used to confirm fluid accumulation in the corresponding area of the ultrasound system. Significant differences in both H + 2 and complexity were observed among the three groups (with hyperintense area, without hyperintense area, and unaffected side) (p < 0.05). Post hoc analysis (Mann-Whitney U test; Bonferroni correction p < 0.0167) revealed a significant difference for "complexity." The evaluation of the distribution in Euclidean space showed that the variation of the distribution decreased in the order of unaffected, without hyperintense area, and with hyperintense area. Conclusion: The "complexity" of the fractal using virtual volume seems to be an effective indicator of the presence or absence of subcutaneous tissue fluid accumulation in BCRL.

The relationship between the degree of subcutaneous fluid accumulation and the lymphatic diameter.

BACKGROUND: The relationship between the fluid accumulation in the subcutaneous tissue and the lymphatic degeneration in the lymphedematous limbs has not been elucidated, and we have evaluated it in the current study. METHODS: Twenty-five patients (50 limbs) were included in this retrospective study. We performed lymphatic ultrasound by separating the limbs into four lymphosomes: the saphenous (medial) thigh, saphenous (medial) calf, lateral thigh, and lateral calf. In each lymphosome, the lymphatic diameter, the degree of lymphatic degeneration, and the fluid accumulation in the subcutaneous tissue were evaluated. The lymphatic vessels were detected based on the index of D-CUPS (Doppler, Crossing, Uncollapsibe, Parallel, and Superficial fascia). Lymphatic degeneration was diagnosed based on the NECST (Normal, Ectasis, Contraction, and Sclerosis Type) classification. RESULTS: All patients were women with a mean age of 62.7 years. Lymphatic vessels were detected using lymphatic ultrasonography in 50 saphenous (medial) thigh lymphosomes, 43 saphenous (medial) calf lymphosomes, 34 lateral thigh lymphosomes, and 22 lateral calf lymphosomes. The fluid accumulation tended to be more acute in the more severe stages of lymphedema. As for the NECST classification, the normal type was observed only in the areas without fluid accumulation. Among the other areas, the percentage of contraction type was the largest in the area with slight edema and decreased in the areas with severe edema. CONCLUSION: The lymphatic vessels were dilated to a greater extent in legs with more severe fluid accumulation. Therefore, there is no hesitation needed to perform lymphaticovenous anastomosis because of severe lymphedema.

A Tuned Microwave Resonant System for Subcutaneous Imaging.

A compact and planar imaging system was developed using a flexible polymer substrate that can distinguish subcutaneous tissue abnormalities, such as breast tumors, based on electromagnetic-wave interactions in materials where permittivity variations affect wave reflection. The sensing element is a tuned loop resonator operating in the industrial, scientific, and medical (ISM) band at 2.423 GHz, providing a localized high-intensity electric field that penetrates into tissues with sufficient spatial and spectral resolutions. The resonant frequency shifts and magnitudes of the reflection coefficients indicate the boundaries of abnormal tissues under the skin due to their high contrasts to normal tissues. The sensor was tuned to the desired resonant frequency with a reflection coefficient of -68.8 dB for a radius of 5.7 mm, with a tuning pad. Quality factors of 173.1 and 34.4 were achieved in simulations and measurements in phantoms. An image-processing method was introduced to fuse raster-scanned 9 × 9 images of resonant frequencies and reflection coefficients for image-contrast enhancement. The results showed a clear indication of the tumor's location at a depth of 15 mm and the capability to identify two tumors both at the depth of 10 mm. The sensing element can be expanded to a four-element phased array for deeper field penetration. Field analysis showed the depths of -20 dB attenuation were improved from 19 to 42 mm, giving wider coverage in tissues at resonance. Results showed that a quality factor of 152.5 was achieved and a tumor could be identified at a depth of up to 50 mm. In this work, simulations and measurements were conducted to validate the concept, showing great potential for subcutaneous imaging in medical applications in a noninvasive, efficient, and lower-cost way.

Sonographic features of secondary involvement of skin and subcutaneous tissues by hematologic malignancies.

OBJECTIVES: To evaluate the sonographic features of secondary involvement of skin and subcutaneous tissues by hematologic malignancies. METHODS: A review of the ultrasound and pathology databases yielded 10 cases with 13 skin and subcutaneous tissue lesions secondary to hematologic neoplasms, which were confirmed by pathology. We used ultrasound to assess the number, location, size, depth of involvement, echogenicity, and vascularity of the lesions. RESULTS: The study involved five male and five female patients, including four leukemia, two multiple myeloma, and four lymphoma patients. The average age was 45 years (17-66 years). Three patients presented with one lesion, four with two lesions, and three with more than two lesions. All the lesions were located in the trunk and extremities. The lesions ranged from 1.2 to 8.3 cm in size. A total of 10 lesions involved subcutaneous fat tissue. A total of 10 lesions displayed hypoechoic foci within a hyperechoic background, and three appeared hypoechoic, and most of them exhibited abundant vascularity (12 of 13 lesions). CONCLUSIONS: Secondary involvement of skin and subcutaneous tissues by hematologic malignancies often present with multiple palpable masses showing the following ultrasound features: (1) subcutaneous fat infiltration, (2) hypoechoic foci with a hyperechoic background, and (3) abundant vascularity.

In Vivo Analysis of the Superficial and Deep Fascia.

BACKGROUND: Key risk factors for hypertrophic scarring and surgical-site infections are high-tension wounds, fat necrosis, and dead space. All could be prevented by appropriate superficial fascia suturing. However, the as-yet poorly researched anatomy of the superficial fascia should be delineated. This study is the first to quantify the superficial fascia throughout the human body in vivo. METHODS: Ultrasound was used to analyze the superficial and deep fascia of 10 volunteers at 73 points on 11 body regions, including the upper and lower trunk and limbs. Number, thickness and percentage of superficial fascia layers, and deep fascia and dermis thickness, were measured at each point. RESULTS: Seven hundred thirty ultrasound images were analyzed. Body regions varied markedly in terms of subcutaneous variables. Posterior chest had the thickest deep fascia and dermis and the highest average superficial fascia layer thickness [0.6 mm (95 percent CI, 0.6 to 0.7 mm)]. Anterior chest had the most superficial fascia layers [3.7 (95 percent CI, 3.5 to 3.8)]. Posterior and anterior chest had among the highest percentage of superficial fascia. Abdomen and especially gluteus had a low percentage of superficial fascia. Covariate analyses confirmed that posterior and anterior chest generally had higher superficial fascia content than gluteus and abdomen (both p < 0.001). They also showed that the dermis in the posterior and anterior chest increased proportionally to total fascia thickness. CONCLUSIONS: The superficial fascia, deep fascia, and dermis tend to be thick in high-tension areas such as the upper trunk. A site-specific surgical approach is recommended for subcutaneous sutures. CLINICAL RELEVANCE STATEMENT: Understanding the anatomical distribution of the superficial fascia and deep fascia will help surgeons optimize subcutaneous fasciae suturing, thereby potentially reducing the incidence of surgical-site infections and hypertrophic scars.

Correlative Ultrasound Evaluation of Anterior Abdominal Wall Subcutaneous Tissue Thickness in Type 2 Diabetic and Non-Diabetic Adults.

BACKGROUND: Subcutaneous fat accumulation complicating diabetes mellitus (DM) has long been recognised, even as its clinical significance remains controversial. Ultrasound is safe and accurate in assessing soft tissue dimensions. Reports on ultrasound evaluation of anterior abdominal wall subcutaneous fat in diabetic and apparently healthy normoglycaemic subjects are scanty in the Nigerian environment. AIMS AND OBJECTIVES: To sonographically assess and compare the mean anterior abdominal wall subcutaneous tissue thickness (AAST) in adult diabetic subjects and apparently healthy, normoglycaemic subjects and correlate the values with age, gender, body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) and glycated hemoglobin (Hb1c). MATERIALS AND METHODS: The AAST in 150 adult diabetic subjects and equal numbers of age, and sex matched apparently healthy individuals was assessed with a SONOACE X4 ultrasound scanner. (Medison Inc, SOUTH KOREA), using a l inear array transducer of frequency 7. 5MHz10MHz.Measurements were taken in the midline at two points; 2cm above and below the umbilicus. Anthropometric parameters such as BMI, WC, WHR, were recorded. RESULTS: Adult diabetic subjects had significantly higher AAST values, compared to age and BMI matched male and female apparently healthy controls respectively. (2.7±0.9cm vs 2.2 ± 0.9cm (below the umbilicus; p=0.001), and 2.1 ± 0.8cm vs 1.6 ± 0.8cm (above the umbilicus; p = 0.001). Below the umbilicus, AAST correlated positively with WHR, BM1 and disease duration among diabetic patients. CONCLUSION: AAST is significantly increased in diabetic subjects compared to controls, and can be a useful guide in the management of obesity in these patients. There is correlation of AAST below the umbilicus with BMI and waist circumference.

CONTEXTE: Accumulation de graisse sous-cutanée compliquant le sucré (DM) est reconnu depuis longtemps, même s'il est linique l'importance est restée controversée. L'échographie est sûre et précise dans l'évaluation des dimensions des tissus mous. Rapports sur l'évaluation échographique de graisse sous-cutanée de la paroi abdominale antérieure chez le diabétique et apparemment les sujets normogl ycémiques en bonne sant é sont rares au Ni géri a environnement. BUTS ET OBJECTIFS: Évaluer et comparer par échographie l'épaisseur moyenne du tissu sous-cutané de la paroi abdominale antérieure(AAST) chez les sujets diabétiques adultes et apparemment en bonne santé, normoglycémique sujets et corréler les valeurs avec l'âge, le sexe,indice de masse corporelle (IMC), tour de taille (WC), taille à hanchesrapport (WHR) et hémoglobine glyquée (Hb1c). MATÉRIAUX ET MÉTHODES: L'AAST chez 150 diabétiques adultes sujets et nombre égal d'âge et de sexe apparié apparemment en bonne santé ont été évalués à l'aide d'un échographe SONOACEX4.(Medison Inc, CORÉE DU SUD), en utilisant un transducteur linéaire defréquence 7.5 MHz-10 MHz.Des mesures ont été prises dans la ligne médianeen deux points; 2cm au-dessus et au-dessous de l'ombilic. Anthropométrique des paramètres tels que l'IMC, WC, WHR, ont été enregistrés. RÉSULTATS: Les sujets diabétiques adultes avaient un AAST plus élevé valeurs, par rapport à l'âge et à l'IMC appari és hommes et femmes apparemment cont rôl es sai ns respectivement. (2.7±0.9 cm vs 2.2 ± 0.9 cm (sous leombilic; p=0.001), et 2.1 ± 0.8cm contre 1.6 ± 0.8cm (au-dessus de laombilic; p = 0.001). Sous l'ombilic, AAST corrélépositivement avec WHR, BM1 et durée de la maladie chez les diabétiques patient. CONCLUSION: AAST est significativement augmenté chez lessujets diabétiques par rapport aux contrôles, et peut être un guide utile dans la gestion d' obésité chez ces patients. Il y a une corrélation de l'AAST sous l'ombilic avec IMC et tour de taille. Mots-clés: Paroi abdominale antérieure, diabète, obésité, tissus mous,ultrason.

Identifying subcutaneous tissue microcalcification by Fluo-3 AM imaging in cutaneous calciphylaxis.

Calciphylaxis, also known as calcific uremic arteriolopathy (CUA), is typically characterized by subcutaneous tissue calcification and excruciatingly painful cutaneous lesions with high mortality. It is critical for dermatologists to make early diagnosis and appropriate management, yet currently only 56% of calciphylaxis cases are correctly diagnosed by conventional histological stain1. Specially, the identification of subtle calcium deposits of subcutaneous can be challenging but is believed crucial for early diagnosis of calciphylaxis2. More sensitive calcification staining is in high demand. In this study, Fluo-3 AM was found to be a rapid, sensitive and reliable fluorescent probe for the detection of calcium deposits and could be a promising diagnostic tool for calciphylaxis.

Computed Tomography-Based Quantitative Analysis of Fibrotic Changes in Skin and Subcutaneous Tissue in Lower Extremity Lymphedema Following Gynecologic Cancer Surgery.

Background: Lymphedema produces protein-rich fluids that aggravate inflammation in the skin and subcutaneous tissue. Inflammation then induces fibroadipose tissue deposition and fibrosis. However, few methods have been developed to evaluate the severity of fibrosis. Therefore, we aimed to evaluate the subcutaneous fibrotic changes in lower extremity lymphedema following gynecologic cancer surgery using an image analysis tool, the FIJI software. Methods and Results: Seventy-four patients with lymphedema following gynecologic surgery were enrolled in this study. We quantitatively analyzed the cross-sectional area (CSA) of soft tissue compartments, including subcutaneous tissue with the skin, muscle volume, fibrotic changes in subcutaneous tissue, and the perimeter of skin boundaries. The limb circumference and the CSA of the subcutaneous tissue and skin on the affected side were significantly larger than those on the unaffected side. Fibrotic changes showed the same trend. However, muscle volume patterns were different from those of the other compartments. Some patients showed lower muscle volume on the unaffected side than on the affected side. Circumference and cellulitis significantly affected the extent of fibrotic changes in the skin and subcutaneous tissues. Age and duration of lymphedema did not affect fibrosis. Conclusion: Fibrosis of subcutaneous regions with the skin can be quantitatively calculated using an image analysis tool in lower extremity lymphedema following gynecologic cancer surgery. Edema and cellulitis increase fibrotic changes in the subcutaneous tissue with the skin.

Prediction of the Presence of Fluid Accumulation in the Subcutaneous Tissue in BCRL Using Texture Analysis of Ultrasound Images.

Background: Breast cancer-related lymphedema (BCRL) is a chronic swelling of the arm due to breast cancer treatment. Lymphedema is diagnosed and staged on the basis of limb circumference measurements and the patient's subjective symptoms, which have poor reproducibility and objectivity: these cannot detect any fluid accumulation in the tissue. Ultrasonography is a feasible noninvasive technique that can be used to evaluate tissue structure in real time. This study aimed to assess the ability of texture features for discriminating the presence of accumulated fluid within the subcutaneous tissue of BCRL using ultrasound (US) imaging. Methods and Results: This study included 20 women who were treated for unilateral breast cancer and who subsequently developed BCRL (International Society of Lymphology stage II). Subcutaneous tissue was scanned through an US system (Sonosite Edge II; Sonosite, Inc., FUJIFILM) using a 6- to 15-MHz linear transducer to assess the ability of texture features for discriminating the presence of accumulated fluid within the subcutaneous tissue of BCRL. Fluid accumulation was observed using a 3-Tesla MR system under double-echo steady-state conditions. There was a significant difference among the three groups (with hyperintense area, without hyperintense area, and unaffected side) in 11 of 14 textural features (p < 0.05). Post hoc analysis (Mann-Whitney U test; Bonferroni correction p < 0.0167) revealed significant differences in seven textural features within the hyperintense area. Conclusions: This study revealed that seven texture features quantified by US imaging data can provide information regarding fluid accumulation in the subcutaneous tissue of lymphedema.

Ultrasound findings in subcutaneous plantar vein thrombosis: retrospective analysis of seven patients.

BACKGROUND: Several disorders may result in forefoot pain. An uncommon cause of forefoot pain is subcutaneous plantar veins thrombosis (SCPVT) involving veins superficial to the plantar fascia. PURPOSE: To describe the ultrasound (US) appearance of SCPVT, which has been described only once in the radiological literature. MATERIAL AND METHODS: We performed a retrospective search of our PACS system from 2016 to 2020 to collect all cases of US-diagnosed SCPVT. We collected data on seven patients. Two radiologists analyzed the US images retrieved. All US examinations were performed with a multifrequency linear probe (frequencies in the range of 5-17 MHz). RESULTS: A localized plantar nodule was palpable in 86% of patients. The subcutaneous thrombosed vein appeared in all patients as a round or ovoid nodule located in the subcutaneous tissues that corresponded in four patients (4/5, 80%) to the painful palpable nodule. The size was in the range of 4-7 mm (mean = 5.4 mm). The thrombosed vein presented a connection with adjacent patent veins, appeared enlarged, and almost filled with hypo-isoechoic material, and in two patients (2/7, 29%), a thin peripheral fluid component surrounding the thrombus was detectable. Continuous scanning demonstrated slow blood movements inside the peripheral component due to blood circulation. Failure to compress the lumen of the thrombosed vein during the real-time US was evident in all patients. CONCLUSION: SCPVT is a rare or underreported condition. Sonologists must know the US appearance of SCPVT to exclude other conditions and avoid unnecessary invasive studies.

Case Report: Disseminated Cysticercosis due to Intentional Ingestion of Parasitic Worm Eggs for Weight Loss.

A 20-year-old female resident of Beijing intended to consume the eggs of the parasitic worm, Taenia saginata, for weight loss; however, she apparently inadvertently ingested Taenia solium (pork tapeworm) eggs, which resulted in disseminated cysticercosis. Cysticerci developed in the brain, tongue, muscles, liver, peritoneum, and subcutaneous tissues. She was administered oral albendazole and praziquantel. After four 10-day courses of treatment, most of the cysts disappeared and she recovered. After 3 years, the patient remains in good health.

Non-invasive evaluation techniques to efficacy of anti-cellulite treatment: the high frequency (HF) ultrasound as a useful imaging technique of the skin and subcutaneous tissue.

Cellulite is defined as lipodystrophy of the subcutaneous adipose tissue, is a serious problem for about 90% of women. The fight against the symptoms is a challenge for cosmetology and esthetic medicine. The most promising method of skin and subcutaneous tissue imaging appears to be the ultrasound method. The aim of the study was to evaluate the effectiveness of classic and high frequency ultrasonography in monitoring the anti-cellulite treatment. The study involved 144 women at mean age of 40.01 (± 11.90) years. The women were divided into groups: due to age and due to the degree of cellulite. The study was divided into two stages: "before" treatment (stage I) and "after" treatment (stage II), to which patients reported after a monthly anti-cellulite specifics application. In the initial phase, inspection and palpation tests have been executed to determine the severity of cellulite.The Nümberger-Müller cellulite severity assessment scale has been used. All women had a thigh circumference measured at its widest point. Epidermal tests have been performed in all women in order to eliminate allergy to preparation components. Based on the study, it was observed that there was a significant reduction in the thickness of the subcutaneous tissue as a result of therapy. The reduction of thickness of the dermis after treatment may indicate improvement in microcirculation which leads to elimination of edemas. A reduction of thigh circumference, which is one of the main indicative parameters of the therapy effectiveness, has been obtained.

Dermatologic ultrasound in the management of childhood linear morphea.

Linear morphea is the most common subtype of localized scleroderma in the pediatric population. This condition can be quite disabling, with complications such as growth defects and painful flexion contractures. Assessment of disease progression and early intervention are key to minimize morbidity. We report linear morphea in a previously healthy 12-year-old girl. The patient presented with a one-year history of a linear plaque crossing her left antecubital fossa, measuring 7x3cm. The diagnosis was confirmed by biopsy, in which deep tissue involvement was noted. Subsequent management and evaluation of the disease activity was done by ultrasound, which allowed precise guidance of pharmacotherapy. The patient improved both clinically and sonographically with a methotrexate course. Sonographic changes accurately described the disease activity on follow up assessments. Features suggestive of an active phase include a thickened and hypoechoic dermis contrasting hyperechoic subcutaneous tissue. The atrophic stage is characterized by a thinned-out dermis and subcutaneous area. Typical vascular traits of each disease phase can also contribute to the assessment. Ultrasound is a grossly underused tool in the field of dermatology. It can provide accurate and sensitive information about disease activity in linear morphea, allowing for more timely intervention and optimal patient management.