Fine-Needle Aspiration as a Method of Diagnosis of Subcutaneous Fat Necrosis of the Newborn.

A 5-day-old boy presented with cellulitis-like, fluctuant lesions since birth. Clinically, subcutaneous fat necrosis was suspected, but an infective lesion could not be excluded. By performing a fine-needle aspiration biopsy, a diagnosis was established within minutes.

Progressive fat necrosis after breast augmentation with autologous lipotransfer: a cause of long-lasting high Fever and axillary lymph node enlargement.

UNLABELLED: Breast augmentation with autologous fat transfer has been widely practiced. However, this procedure is not exempt from complications even after technique refinement. This article aims to describe a case of long-lasting high fever, axillary node enlargement, and upper extremity dysfunction caused by liponecrosis after breast fat injection. Radiological and histological examination confirmed liponecrosis in bilateral breasts. Aspiration, drainage, and irrigation were performed along with empirical antibiotic treatment. The patient has made a full recovery from the operation. Liponecrosis, one of the complications after autologous fat grafting to the breast, may present widely different symptoms and signs. Even experienced surgeons should not underestimate it and caution should be used to maintain safety during and after the procedure. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Nodular cystic fat necrosis with calcification in a patient with juvenile dermatomyositis.

Nodular cystic fat necrosis is a rare, benign form of encapsulated fat necrosis with distinct histology, characterized by cystic fat necrosis with lipomembranous changes and, in later stages, calcification. We report the case of a 7-year-old child with juvenile dermatomyositis who presented with three asymptomatic, firm, mobile nodules on the arms and neck. Histology was consistent with nodular cystic fat necrosis with prominent calcification. This is an unusual presentation of this entity because it has never been previously reported in association with juvenile dermatomyositis.

Sonography of fat necrosis of the breast: correlation with mammography and MR imaging.

Fat necrosis (FN) of the breast is a benign nonsuppurative inflammatory process of the adipose tissue. The radiologic appearance ranges from benign to suspicious for malignancy; therefore, it is very important to know the distinguishing radiologic features of FN on different modalities. Mammography is more helpful in identifying FN than ultrasonography in most of the cases, and MRI may also be used to rule out malignancy as an adjunct to mammography and sonography. Even when modern diagnostic modalities are used, biopsy may still be unavoidable for some cases. In conclusion, an accurate history and familiarity with the radiologic findings are crucial to recognizing FN and avoiding unnecessary interventions.

Panniculitis in children.

This paper will give a comprehensive view of the most frequent panniculitides seen in childhood, with emphasis on the types exclusively found in infancy, and for all other types of panniculitides also found in adults. Aim of this paper is also to analyze the clinical differences between panniculitis in childhood and in adulthood, and to give reliable histopathologic criteria for a specific diagnosis. A review of the literature is here integrated by authors' personal contribution. Panniculitides in children is a heterogeneous group of diseases, as well as in adult life, characterized by inflammation of the subcutaneous fat. Only very few types of panniculitis are exclusively found in childhood, such as Sclerema neonatorum and subcutaneous fat necrosis of the newborn, while the vast majority of the other types may be found both in paediatric age and in adults. Furthermore, this paper will consider in detail panniculitis according to their frequency, such as Erythema nodosum, Lupus panniculitis, Cold panniculitis, panniculitis in Behçet disease, and poststeroid panniculitis. It will also describe rare forms of panniculitis, such as Eosinophilic panniculitis (a pathological entity debated by many authors), Subcutaneous panniculitis T-cell lymphoma, and the different forms of the so call "Lipophagic panniculitis", encompassing respectively the febrile relapsing panniculitis of Weber-Christian disease and the non-relapsing form of Rothmann-Makai disease. For each type of panniculitis considered concise information will be given about epidemiology, etiology, clinical findings, laboratory data, prognosis and therapy, while histopathologic findings will be described in detail.

The treatment of symptomatic fat necrosis: A review and introduction of a new treatment algorithm.

OBJECTIVE: Fat necrosis (FN) is a well-known complication in plastic surgery. Excision of symptomatic FN has been the gold standard, but it often results in contour irregularities that require subsequent treatment. Different alternative surgical and nonsurgical management strategies have been described; however, there are currently no guidelines. This literature review aims to provide an overview of available treatment options and current management standards to support clinical decision making. METHOD: A literature search in the databases PubMed, Embase (via Ovid), and Web Of Science was carried out to identify eligible articles. The search strategy included combinations of the following terms: "Fat necrosis "AND (treatment OR management OR therapy). Six articles discussing or reporting management strategies of FN in a plastic surgery context were included. RESULTS: A variety of techniques were used to manage symptomatic FN. Asymptomatic or small lesions can be treated conservatively. Oil cyst and moderately sized areas of symptomatic FN can effectively be treated by aspiration, ultrasound-assisted liposuction, or needle aeration. Calcified and large areas of FN require excision and debridement of necrotic fat tissue CONCLUSION: At present, there is no consensus on the management of symptomatic FN. The authors propose a new classification system to aid the guidance of management of symptomatic FN.

A 1-week-old newborn with hypercalcemia and palpable nodules: subcutaneous fat necrosis.

We present a 1-week-old newborn with subcutaneous fat necrosis complicated by hypercalcemia. She received conservative treatment of adequate hydration and restricted supplementary vitamin D.

Management of Fat Necrosis after Autologous Fat Transplantation for Breast Augmentation.

BACKGROUND: Palpable lumps as sequelae of fat necrosis after fat grafting to the breast may not only cause physical or psychological symptoms to patients but also potentially complicate breast cancer screening. In this article, the authors present their experience in management of fat necrosis following fat grafting for breast augmentation. METHODS: Over a 5-year period, a total of 685 Asian women (age range, 20 to 58 years) underwent autologous fat transplantation to the breasts. The average volume of fat graft to each breast was 205 ± 45 cc. The preoperative and postoperative photographs and the breast volume were recorded. Detection of fat necrosis was based on clinical examinations and imaging studies. The mean follow-up was 208 ± 36 days. RESULTS: The mean volume increase was 135 ± 20 cc in a single breast, with a mean graft retention rate of 65 percent. Sixty-six patients (9.6 percent) were found to have fat necrosis in the form of solitary or multiple cysts, sclerotic nodules, or calcifications in either one or both breasts postoperatively. The average time before first detection of the breast lump was 108 ± 45 days. Management of fat necrosis included aspiration or excision based on the authors' treatment algorithm. The symptoms related to fat necrosis such as discomfort on palpation, pain, or possible skin reaction were significantly improved in 54 of 57 patients (94.7 percent). CONCLUSIONS: Fat necrosis following autologous fat grafting for breast augmentation can be managed successfully and its related symptoms can be relieved in 94.7 percent of patients. It can be approached safely based on a sound algorithm developed by the authors. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

[Neonatal cytosteatonecrosis complicated by major hypercalcemia]. / Cytostéatonécrose néonatale compliquée d'hypercalcémie majeure.

We here report the case of a female infant with perinatal asphyxia requiring resuscitation. She was referred with sclerema neonatorum which had been observed by parents on her tenth day of life. The lesions appeared as hard erythematous nodular plaques, suggesting neonatal cytosteatonecrosis in the gluteal region. Patient's evolution was marked by progressive hypercalcemia reaching a peak of 128 mg/L (80-110 mg/L) for which re-hospitalization was required 1 month after birth. Renal ultrasound showed medullary nephrocalcinosis. Treatment was based on hyperhydration associated with diuretics, corticosteroids and abstention from vitamin D administration as well as on clinical and laboratory monitoring of serum calcium levels. A month later, cutaneous lesions were regressing and calcium levels were normalizing. The patients is still undergoing ultrasound monitoring.

Fat necrosis and polymicrobial wound infection caused partly by Raoultella ornithinolytica after reduction mammoplasty.

Raoultella ornithinolytica is a rare opportunistic aerobic gram-negative bacillus that naturally exists in soil, water and plants. The pathogen has been described in association with diabetic foot infections, biliary infections, bacteraemia and native and prosthetic joint infections. Fat necrosis and wound infection following breast reduction surgery or other plastic surgeries caused by this pathogen have not been previously described. We present a case of bilateral fat necrosis, wound infection and dehiscence in a 24-year-old woman with no significant past medical problems. She initially had an uneventful early postoperative course but 3 weeks after surgery noticed pain and discharge from both nipple/areola area of both breasts which later developed into full-thickness fat necrosis and complete destruction of the nipple areolar complex. R. ornithinolytica, Escherichia coli and Enterococcus faecalis were identified from wound exudate cultures. She was treated with surgical debridement and 2 weeks of appropriate antibiotics with a favourable outcome.

Subcutaneous Fat Necrosis of the Newborn: Report of Five Cases.

Subcutaneous fat necrosis of the newborn (SCFN) is a rare, self-limited disorder of the panniculus which appears in the first few weeks of life. SCFN generally follows an uncomplicated course. However, there are important complications for which the patient must be regularly monitored, including thrombocytopenia, hypoglycemia, hypertriglyceridemia, and most importantly, hypercalcemia. We report five infants with SCFN. All children were born at term. The onset of lesions was between 1 day and 20 days after birth. The back was the most frequent location. Birth hypoxia was the most frequent risk factor. Complications included hypercalcemia, hypoglycemia, and metastatic calcifications (disseminated subcutaneous calcifications, nephrocalcinosis, and myocardial calcifications). This study provides the first case of SCFN in the context of hypoxic encephalopathy and refractory septic shock that required extracorporeal membrane oxygenation (ECMO).

Mediastinal (Epipericardial) Fat Necrosis: An Overlooked and Little Known Cause of Acute Chest Pain Mimicking Acute Coronary Syndrome.

Necrosis of the fat adjacent to the heart, referred to as pericardial fat necrosis, epipericardial fat necrosis, and mediastinal fat necrosis, is a rare, self-limited condition. It presents as a sudden onset of severe chest pain that mimics symptoms of pulmonary embolism and acute coronary syndrome. Computed tomography (CT) findings are quite typical and consist of a round- or oval-shaped mass-like lesion containing soft tissue and fat density components in the cardiophrenic space. Lack of familiarity with this condition has led in the past to surgical interventions to remove the mass-like mediastinal fat necrosis. Until the early 2000s, surgical removal of these lesions was deemed the treatment of choice, to exclude a neoplasm. However, the observation that the CT findings of the paracardiac mass resemble fat necrosis seen in other parts of the body and its involution on follow-up CT has led to the realization that the process is a benign and self-limiting one. A dramatic shift in the paradigm of treatment has ensued and surgical treatment is no longer advocated. Awareness of this condition is, therefore, vital so as to diagnose it accurately and avoid unnecessary future surgical interventions.

Treatment of complications after breast-conservation therapy.

Over the past 2 decades, breast-conservation therapy with lumpectomy and whole-breast radiotherapy has become a standard option for the majority of women with newly diagnosed breast cancer. Long-term local control is achieved in approximately 85% of patients, and the therapy is generally well tolerated. There can, however, be long-term effects on the breast and other nearby tissues that may range from asymptomatic findings on examination to severe, debilitating problems. Infection, fat necrosis, and severe musculoskeletal problems such as osteoradionecrosis or soft-tissue necrosis are uncommon, affecting less than 5% of patients. However, changes in range of motion, mild-to-moderate musculoskeletal pain, and arm and breast edema are much more common. As more women choose breast-conservation therapy for management of their breast cancer, physicians will encounter these problems, as well as in-breast tumor recurrence, with greater frequency. This review will focus on the incidence, contributing factors, and management of the late problems of infection, fat necrosis, musculoskeletal complications, and local recurrence following breast-conservation therapy.

Neonatal skin disorders.

Skin disorders are commonly seen in the neonatal period. A recent survey of neonates demonstrated that almost every neonate had some skin lesion. The most common skin findings are desquamation, Epstein's pearls, sebaceous hyperplasia, milia, toxic erythema, salmon patch, hypertrichosis, and Mongolian spot. In addition to these common cutaneous findings, other disorders may exist and are discussed in this article.