Abstract
This study aimed to present the ‘dot-in-circle’ sign, which indicates the typical magnetic resonance imaging (MRI) and ultrasonographic (USG) findings for mycetoma involving soft tissue and bone. A total of 8 cases with histopathological proof of mycetoma affecting the musculoskeletal system, and that were examined via MRI and/or coexistent diagnostic ultrasonography between 2004 and 2013 in Songklanagarind Hospital were included in this study. The ‘dot-in-circle’ sign on the MRI and USG images of all the patients was reviewed by two radiologists. The analytic method was descriptive. All cases of musculoskeletal mycetoma revealed the ‘dot-in-circle’ sign on MRI, which was seen as multiple, small, round- to oval-shaped hyperintense lesions separated and surrounded by a low-signal intensity rim (circle), and a tiny, central, low-signal focus (dot). An USG study was available in four patients, and all USG findings demonstrated the ‘dot-in-circle’ sign as a central hyperechoic area (dot) surrounded by hypoechoic tissue (circle). In conclusion, the ‘dot-in-circle’ sign is a typical feature on MRI and USG findings for the diagnosis of musculoskeletal mycetoma.
Highlights
Mycetomas are chronic infections of the skin, underlying soft-tissues, sometimes bones, and rarely viscera, and they are caused by both bacteria and fungi (Hay 2008)
A review was conducted of the medical records in the Hospital Information System (HIS) to evaluate patients that were diagnosed with soft-tissue mycetoma and had undergone magnetic resonance imaging(MRI) and/or coexistent diagnostic ultrasonography (USG) at the Department of Radiology, Songklanagarind Hospital, a tertiary-level hospital in Southern Thailand, during the 2004 – 2013 period
All of them had a clinical history of soft-tissue swelling and complained of a mass at the involved location
Summary
Mycetomas are chronic infections of the skin, underlying soft-tissues, sometimes bones, and rarely viscera, and they are caused by both bacteria (actinomycetomas) and fungi (eumycetomas) (Hay 2008). Mycetoma is more frequent in tropical and subtropical regions (Fahal and Hassan 1992). In the African continent, Sudan, the prevalence is highest (Fahal et al 2014). The first description of mycetoma of the foot was made in the city of Madura, India in 1846 - the eponym “Madura foot” has been used (Lewall et al 1985). As a result of the increasing numbers of migrant populations, cases are reported in endemic regions, and in Western countries (Ahmed et al 2003; White et al 2014). The disease commonly involves parts of the body that are in direct contact
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