Fat Nodules Research Articles

Surgical Removal of Fat Nodules Formed in the Tear Trough After Autologous Fat Grafting.

Autologous fat grafting is a common treatment for tear trough deformities. This procedure involves a potential complication of fat nodule formation, leading to abnormal bulging of the lower eyelid. However, limited information exists about this complication, and an effective treatment is lacking. The present study aimed to present a novel surgical approach for the removal of fat nodules caused by autologous fat grafting in the tear trough. This retrospective study included 33 patients who underwent surgery for the removal of fat nodules formed after autologous fat grafting. The procedure was performed using a conjunctival approach, allowing exposure and removal of all fat nodules in the anterior septal space, with the method adapted according to the severity of the deformity. A total of 66 eyelids were treated surgically, including 30 (45.45%) with mild nodular deformity, 23 (34.85%) with moderate nodular deformity, and 13 (10.70%) with severe nodular deformity. A second surgical procedure was required on 3 eyelids (4.56%). The main complications of the surgery were conjunctival congestion (21.21%), and localized depression (18.18%), bruising (12.12%). Among the patients, 29 (87.88%) were satisfied and 4 (12.12%) were dissatisfied with the treatment results. Conjunctival approach surgery is an effective method of removing fat nodules formed after autologous fat grafting in the tear trough, with good results and high levels of patient satisfaction. This approach enables the effective management of a common complication of autologous fat grafting and may enable the wider application of autologous fat grafting in the periorbital region. 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 .

Técnica médica método Namihira para el tratamiento del lipedema: presentación de casos clínicos

Introduction. Lipedema, a chronic adipose tissue disorder, poses challenges in its diagnosis and medical treatment. Despite affecting 11 - 20% of women, it often goes unnoticed due to its resemblance to other conditions. Current treatment options range from conservative approaches to surgical interventions, with liposuction the most effective. This article introduces the Namihira method, a minimally invasive medical technique challenging the traditional paradigm of lipedema treatment. Case Presentation. Four successful cases of patients treated with the Namihira method are presented following a lipedema diagnosis. These cases demonstrate the clinical benefits of the method: progressive reduction in pain, volume and improvement in texture, with a minimal recovery time. The average duration of the procedure was 150 minutes, and all patients resumed low - impact physical activities immediately. Results and Conclusions. The Namihira method offers significant medical and aesthetic results while minimizing complications. Results include a notable reduction in pain, decreased fat nodules, and a lower incidence of hematomas. Additionally, an average weight loss of up to 2.500 kg at the end of the protocol was observed. The method stands out for its accessibility, short procedure time, and lower costs, positioning it as a compelling therapeutic option for lipedema and localized adiposity. Nevertheless, more long - term research is required for this procedure.

Fat-containing hepatocellular carcinoma in patients with cirrhosis: proposal of a diagnostic modification regarding enhancement characteristics.

The aim of this study was to develop and validate an algorithm for the non-invasive diagnosis of these fat-containing HCCs. Eighty-four cirrhotic patients with 77 fat-containing HCCs and 11 non-HCC fat-containing nodules were retrospectively included. All MRIs were reviewed; nodule characteristics, European Association for the Study of the Liver (EASL) and LI-RADS classifications, and survival were collected. One of the major features of LI-RADS v2018 (non-rim-like arterial phase hyperenhancement [APHE]) was changed to include different enhancing patterns at arterial phase and a new fat-LI-RADS algorithm was created for fat-containing nodules in cirrhosis. Its diagnostic performance was evaluated in both a derivation and external validation cohort (external cohort including 58 fat-containing HCCs and 10 non-HCC fat nodules). Reproducibility of this new algorithm was assessed. In the derivation cohort, 54/77 (70.1%) fat-containing HCCs had APHE, 62/77 (80.5%) had enhancement compared to the nodule itself at arterial phase (APE), 43/77 (55.8%) had washout, and 20/77 (26.0%) had an enhancing capsule. EASL and LI-RADS had a sensitivity of 37.7% (29/77) and 36.4% (28/77), respectively, for the diagnosis of fat-containing HCC and both had a specificity of 100% (11/11). The new fat-LI-RADS algorithm increased sensitivity to 50.6% (39/77) without decreasing the specificity of 100% (11/11). The validation cohort confirmed the increased sensitivity, with a slight decrease in specificity. The concordance for the diagnosis of HCC for fat-LR5 was 85.3% (58/68). The new fat-LI-RADS algorithm proposed here significantly improves the performance of the non-invasive diagnosis of fat-containing HCC and thus could reduce the number of biopsies conducted for fat-containing HCCs. The European Association for the Study of the Liver and LI-RADS guidelines are poorly sensitive for the diagnosis of fat-containing HCC, mainly because of the low rate of arterial phase hyperenhancement (APHE) displayed by fat-containing HCC. Using all types of enhancement instead of APHE improves sensitivity of LI-RADS. • Fat-containing HCCs on MRI account for 7.5% of HCCs and have different imaging characteristics from non-fatty HCCs. • The European Association for the Study of the Liver and LI-RADS algorithms for the non-invasive diagnosis of HCC have low sensitivity for the diagnosis of fat-containing HCC with MRI (37.7% and 36.4%, respectively). • The new fat-LI-RADS, which includes a slight modification of the "arterial enhancement" criterion, improves the sensitivity for the diagnosis of fat-containing HCC using MRI, without degrading the specificity.

Abdominal wall endometriosis: Is structure in imaging related to nodule localisation? A retrospective study

Objective:Investigate the relationship between the structure of abdominal wall endometriotic nodules in MRI and their localisation in abdominal wall layers in order to better understand nodule origins.Design:Women who had an MRI prior to surgical treatment of an abdominal wall endometriotic nodule between 2005 and 2016.Population:Thirty-six patients including four patients with two nodules.Methods:MRI images were reviewed. Each nodule was analysed according to its structure (fibrous, cystic, mixed), localisation (subcutaneous fat, intra muscular, intermediary position), and size.Results:Forty nodules were analysed in MRI with no relationship found between localisation and nodule structure ( p = 0.48). 87.5% of mixed nodules were revealed to have a cystic superficial rim extending towards the subcutaneous fat layer. This finding suggests that the glandular part of the nodule is the active part of the disease from which nodule progression occurs. Intermediary and intramuscular nodules were respectively statistically larger than subcutaneous fat nodules indicating a relationship between nodule size and localisation (35 mm (22–53) vs 17 mm (17–23)) ( p = 0.03).Conclusion:Despite differences in environments surrounding the nodules, no significant relationship between nodule structure in imaging and abdominal wall localisation was found. Data from mixed nodules indicate however the possible role of nodule environment on structure and that the mechanism of nodule growth may be linked to development of cystic superficial rims, at the forefront of disease progression, abdominal wall nodules growing from deep to superficial. Studies are required to further investigate our findings and enable greater understanding of the origins of AWE.

An evaluation of the clinical potential of tissue diffraction studies

Medical imaging is a long established part of patient management in the treatment of disease. However, in most cases it only provides anatomical detail and does not provide any form of tissue characterisation. This is particularly true for X-ray imaging. Recent studies on tissue diffraction have shown that true molecular signatures can be derived for different tissue types. Breast cancer samples and liver tissue have been studied. It has been shown that diffraction profiles can be traced away from the primary tumour in excised breast tissue samples and that potentially 3mm fat nodules in liver tissue can be identified in patients at acceptable doses.

Subcutaneous angiolipoma: magnetic resonance imaging features with histological correlation.

Despite producing pain, angiolipoma is sometimes misdiagnosed as an ordinary small lipoma, which is usually not associated with pain. Few reports have described magnetic resonance (MR) imaging findings of angiolipoma. The aim of the present study was to clarify the MR imaging features of angiolipoma. The MR imaging findings of 11 lesions in 7 patients were reviewed and compared with histopathological findings. The MR imaging features of these lesions were the presence of fat nodules with or without areas of low signal intensity on T1- and T2-weighted images. The location of the low-signal-intensity areas varied. The low-signal-intensity areas were mainly in the peripheral portion of 3 lesions and in the central portion of 5 lesions. No or few low-signal-intensity areas were observed in 3 lesions. In the lesions with peripheral low-signal-intensity areas, lesion marginations were well defined, and the lesions were easily recognized as mass lesions. In the lesions with only central low-signal-intensity areas, marginations were poorly defined, and the lesions were not easy to recognize as mass lesions. In the lesions with few or without low-signal-intensity areas, marginations were invisible. Histopathological studies indicated that the low-signal-intensity areas on T1- and T2-weighted images corresponded to areas of dense capillary proliferation. In lesions with few or without low-signal-intensity areas on MR images, capillaries were thinly spread over almost the entire lesion area. The MR imaging features of angiolipoma are fat nodules with or without low-signal-intensity areas of various size and location on T1- and T2-weighted images.

64 Behind every healthy man, there's a woman: A qualitative inquiry

during the short-term follow-up, with 6 cystic fat nodules. The satisfaction rate for sexual function, morphology and global state were 79.8%, 78.9%, and 91.7%. Conclusions: Our technique shows very effective shortterm outcomes and patient’s satisfaction without serious complications. 62 A case of 47,XXY/46,XY Klinefelter syndrome H. Masuda1, Y. Katsuoka2. 1Aino Hospital, 2 Osaka Medical College, Japan Klinefelter syndrome represents the most commonly found human sex chromosomal abnormality. It is characterized by small, firm testes with hyalinization of the seminiferous tubules, elevated gonadotropins and azoospermia. Males with Klinefelter syndrome may have a 47,XXY or a mosaic 47,XXY/46,XY constitutional karyotype and varying degrees of spermatogenic failure. Mosaicism 47,XXY/46,XX with clinical features suggestive of Klinefelter syndrome is very rare. We report here a case of a mosaic 47,XXY/46,XX infertile male. The patient was a 31-year-old male. Physical examination revealed perfect male-type of genitalia, almost normal penis and bilateral small testicles, being 1.0 × 2.0 × 1.0 cm sized for the right and 1.0 × 2.0 × 1.0 cm for the left. Chromosome analysis by means of culture of peripheral blood lymphocytes revealed twokinds of 46 chromosomes and of 47 chromosomes. The genotype of the former was XX and of the later was XXY, making XX/XXY mosaicism. Testicular sperm extraction was performed, but we could find the sperm in microdissection testicular sperm extraction procedure. Histologically the testicle showed atrophy of seminiferous tubules with hyalinizaition of the canaliculi. No spermatogenesis was observed at all. 63 Coenzyme Q10 treatment for oligoasthenoteratozoospemia in infertile men with varicocele Y. Kobori, H. Okada, G. Arai, S. Soh, H. Yagi. Dokkyo Medical University Koshigaya Hospital, Department of Urology, Japan Objective: To evaluate the effectiveness of coenzyme Q10 treatment in improving semen quality in men who have varicocele with infertility. Patients: Sixty-nine infertile patients (21–51 years of age) with the following baseline sperm selection criteria: concentration 30%. Patients underwent therapy with coenzyme Q10, 30mg/day. We investigated seminograms, background, hormonal analyses. We also investigated the modern ART used to overcome sterility. Results: Coenzyme Q10 and ubiquinol increased significantly sperm concentration, aswell as spermatozoa motility. Intracytoplasmic sperm injection (ICSI) was performed 2 patients, varicocelectomy was performed 1 patient, and total 10 patients are resulted pregnancy. Conclusions:The exogenous administration of coenzyme Q10 increases the level of the same and ubiquinol in semen and is effective in improving sperm kinetic features in patients affected by idiopathic asthenozoospermia with valicocele.

62 A case of 47,XXY/46,XY Klinefelter syndrome

during the short-term follow-up, with 6 cystic fat nodules. The satisfaction rate for sexual function, morphology and global state were 79.8%, 78.9%, and 91.7%. Conclusions: Our technique shows very effective shortterm outcomes and patient’s satisfaction without serious complications. 62 A case of 47,XXY/46,XY Klinefelter syndrome H. Masuda1, Y. Katsuoka2. 1Aino Hospital, 2 Osaka Medical College, Japan Klinefelter syndrome represents the most commonly found human sex chromosomal abnormality. It is characterized by small, firm testes with hyalinization of the seminiferous tubules, elevated gonadotropins and azoospermia. Males with Klinefelter syndrome may have a 47,XXY or a mosaic 47,XXY/46,XY constitutional karyotype and varying degrees of spermatogenic failure. Mosaicism 47,XXY/46,XX with clinical features suggestive of Klinefelter syndrome is very rare. We report here a case of a mosaic 47,XXY/46,XX infertile male. The patient was a 31-year-old male. Physical examination revealed perfect male-type of genitalia, almost normal penis and bilateral small testicles, being 1.0 × 2.0 × 1.0 cm sized for the right and 1.0 × 2.0 × 1.0 cm for the left. Chromosome analysis by means of culture of peripheral blood lymphocytes revealed twokinds of 46 chromosomes and of 47 chromosomes. The genotype of the former was XX and of the later was XXY, making XX/XXY mosaicism. Testicular sperm extraction was performed, but we could find the sperm in microdissection testicular sperm extraction procedure. Histologically the testicle showed atrophy of seminiferous tubules with hyalinizaition of the canaliculi. No spermatogenesis was observed at all. 63 Coenzyme Q10 treatment for oligoasthenoteratozoospemia in infertile men with varicocele Y. Kobori, H. Okada, G. Arai, S. Soh, H. Yagi. Dokkyo Medical University Koshigaya Hospital, Department of Urology, Japan Objective: To evaluate the effectiveness of coenzyme Q10 treatment in improving semen quality in men who have varicocele with infertility. Patients: Sixty-nine infertile patients (21–51 years of age) with the following baseline sperm selection criteria: concentration 30%. Patients underwent therapy with coenzyme Q10, 30mg/day. We investigated seminograms, background, hormonal analyses. We also investigated the modern ART used to overcome sterility. Results: Coenzyme Q10 and ubiquinol increased significantly sperm concentration, aswell as spermatozoa motility. Intracytoplasmic sperm injection (ICSI) was performed 2 patients, varicocelectomy was performed 1 patient, and total 10 patients are resulted pregnancy. Conclusions:The exogenous administration of coenzyme Q10 increases the level of the same and ubiquinol in semen and is effective in improving sperm kinetic features in patients affected by idiopathic asthenozoospermia with valicocele.

65 Effects of Clinacanthus nutans and mebeverine hydrochloride on bladder activity

during the short-term follow-up, with 6 cystic fat nodules. The satisfaction rate for sexual function, morphology and global state were 79.8%, 78.9%, and 91.7%. Conclusions: Our technique shows very effective shortterm outcomes and patient’s satisfaction without serious complications. 62 A case of 47,XXY/46,XY Klinefelter syndrome H. Masuda1, Y. Katsuoka2. 1Aino Hospital, 2 Osaka Medical College, Japan Klinefelter syndrome represents the most commonly found human sex chromosomal abnormality. It is characterized by small, firm testes with hyalinization of the seminiferous tubules, elevated gonadotropins and azoospermia. Males with Klinefelter syndrome may have a 47,XXY or a mosaic 47,XXY/46,XY constitutional karyotype and varying degrees of spermatogenic failure. Mosaicism 47,XXY/46,XX with clinical features suggestive of Klinefelter syndrome is very rare. We report here a case of a mosaic 47,XXY/46,XX infertile male. The patient was a 31-year-old male. Physical examination revealed perfect male-type of genitalia, almost normal penis and bilateral small testicles, being 1.0 × 2.0 × 1.0 cm sized for the right and 1.0 × 2.0 × 1.0 cm for the left. Chromosome analysis by means of culture of peripheral blood lymphocytes revealed twokinds of 46 chromosomes and of 47 chromosomes. The genotype of the former was XX and of the later was XXY, making XX/XXY mosaicism. Testicular sperm extraction was performed, but we could find the sperm in microdissection testicular sperm extraction procedure. Histologically the testicle showed atrophy of seminiferous tubules with hyalinizaition of the canaliculi. No spermatogenesis was observed at all. 63 Coenzyme Q10 treatment for oligoasthenoteratozoospemia in infertile men with varicocele Y. Kobori, H. Okada, G. Arai, S. Soh, H. Yagi. Dokkyo Medical University Koshigaya Hospital, Department of Urology, Japan Objective: To evaluate the effectiveness of coenzyme Q10 treatment in improving semen quality in men who have varicocele with infertility. Patients: Sixty-nine infertile patients (21–51 years of age) with the following baseline sperm selection criteria: concentration 30%. Patients underwent therapy with coenzyme Q10, 30mg/day. We investigated seminograms, background, hormonal analyses. We also investigated the modern ART used to overcome sterility. Results: Coenzyme Q10 and ubiquinol increased significantly sperm concentration, aswell as spermatozoa motility. Intracytoplasmic sperm injection (ICSI) was performed 2 patients, varicocelectomy was performed 1 patient, and total 10 patients are resulted pregnancy. Conclusions:The exogenous administration of coenzyme Q10 increases the level of the same and ubiquinol in semen and is effective in improving sperm kinetic features in patients affected by idiopathic asthenozoospermia with valicocele.

63 Coenzyme Q10 treatment for oligoasthenoteratozoospemia in infertile men with varicocele

during the short-term follow-up, with 6 cystic fat nodules. The satisfaction rate for sexual function, morphology and global state were 79.8%, 78.9%, and 91.7%. Conclusions: Our technique shows very effective shortterm outcomes and patient’s satisfaction without serious complications. 62 A case of 47,XXY/46,XY Klinefelter syndrome H. Masuda1, Y. Katsuoka2. 1Aino Hospital, 2 Osaka Medical College, Japan Klinefelter syndrome represents the most commonly found human sex chromosomal abnormality. It is characterized by small, firm testes with hyalinization of the seminiferous tubules, elevated gonadotropins and azoospermia. Males with Klinefelter syndrome may have a 47,XXY or a mosaic 47,XXY/46,XY constitutional karyotype and varying degrees of spermatogenic failure. Mosaicism 47,XXY/46,XX with clinical features suggestive of Klinefelter syndrome is very rare. We report here a case of a mosaic 47,XXY/46,XX infertile male. The patient was a 31-year-old male. Physical examination revealed perfect male-type of genitalia, almost normal penis and bilateral small testicles, being 1.0 × 2.0 × 1.0 cm sized for the right and 1.0 × 2.0 × 1.0 cm for the left. Chromosome analysis by means of culture of peripheral blood lymphocytes revealed twokinds of 46 chromosomes and of 47 chromosomes. The genotype of the former was XX and of the later was XXY, making XX/XXY mosaicism. Testicular sperm extraction was performed, but we could find the sperm in microdissection testicular sperm extraction procedure. Histologically the testicle showed atrophy of seminiferous tubules with hyalinizaition of the canaliculi. No spermatogenesis was observed at all. 63 Coenzyme Q10 treatment for oligoasthenoteratozoospemia in infertile men with varicocele Y. Kobori, H. Okada, G. Arai, S. Soh, H. Yagi. Dokkyo Medical University Koshigaya Hospital, Department of Urology, Japan Objective: To evaluate the effectiveness of coenzyme Q10 treatment in improving semen quality in men who have varicocele with infertility. Patients: Sixty-nine infertile patients (21–51 years of age) with the following baseline sperm selection criteria: concentration 30%. Patients underwent therapy with coenzyme Q10, 30mg/day. We investigated seminograms, background, hormonal analyses. We also investigated the modern ART used to overcome sterility. Results: Coenzyme Q10 and ubiquinol increased significantly sperm concentration, aswell as spermatozoa motility. Intracytoplasmic sperm injection (ICSI) was performed 2 patients, varicocelectomy was performed 1 patient, and total 10 patients are resulted pregnancy. Conclusions:The exogenous administration of coenzyme Q10 increases the level of the same and ubiquinol in semen and is effective in improving sperm kinetic features in patients affected by idiopathic asthenozoospermia with valicocele.

Ultrasonographic features in complications of cosmetic augmentation with autologous fat obtained by liposuction

Objective To evaluate the ultrasonographic (US) features and evolution of breast fat necrosis after cosmetic augmentation with autologous fat obtained by liposuction, to help distinguish fat necrosis from more ominous breast masses. Methods Breast sonography was performed on 38 patients underwent bilateral breast augmentation by autologous fat injection to evaluate the grafted fat tissues in interval of 3-6 month after the operation. Observations in follow up sonography included the sizes,positions, shape,echogenicity,margin features, calcifications and evolutions of the suspicious nodules in the breasts. Results Seventy-six nodules occurred in 25 of the 38 patients were detected after the fat graft. Among the 76 nodules,52 were cystic(68. 4%) ,8 were complex(10. 5%) and 16 were solid(21.1%). The analysis of the predominant features of the nodules sonographic appearances were as follows: all the nodules had no flow signal, 66 (86. 8%) had clear margins,54(71. 1%) had regular shapes,52 were cystic(68. 4%) ,63(82. 9% ) had no calcifications, 10(13. 2%) had egg-like calcifications,74(97. 4% ) had no halo,and the positions of the solid components in 8 complex nodules move following the change of the detected body position. There were 7 nodules with fat necrosis removed surgically and confirmed by pathology. Conclusions Breast ultrasound is an accurate and simple method to follow up the temporal changes of the fat nodules after autologous fat injection. It may help to avoid unnecessary biopsies. Key words: Ultrasonography; Mamaplasty; Postoperative complications

Sonographic Identification of Complications of Cosmetic Augmentation With Autologous Fat Obtained by Liposuction

To investigate sonographic features and evolution of breast fat nodules after cosmetic augmentation with autologous fat. Breast sonography was performed on 41 patients who underwent bilateral breast augmentation by autologous fat injection. Sonography was initiated 2 to 17 months after the operation. Follow-up sonography evaluated the size, positions, shape, echogenicity, margin features, calcifications, and evolutions of the suspicious nodules in the breasts. We visualized 118 nodules in 34 of the 41 patients after the fat graft. Echotextures in 118 nodules were cystic (73, 61.9%), complex (19, 16.1%), or solid (26, 22%). We observed that 86 of the 118 nodules (72.9%) had circumscribed margins, 94 nodules (79.7%) had regular shapes, 9 nodules (7.6%) had egg-like calcifications, and 106 nodules (98.3%) had no halo. All nodules lacked blood flow signal on color or spectral Doppler. Changes in nodule echotexture were observed during the follow-up. Four nodules changed from solid to complex, one nodule changed from solid to cystic, and one complex nodule exhibited an increased cystic component. The size of the nodules decreased in 13 cases and increased in 20 cases. There were 7 nodules with fat necrosis, which was removed surgically and confirmed by pathology. Breast ultrasound, an accurate and simple imaging technique, plays an important role in follow-up for temporal changes of fat nodules after autologous fat injection. Furthermore, breast ultrasound may avoid unnecessary biopsies.

RECONSTRUCTION OF DEFORMITIES RESULTING FROM PENILE ENLARGEMENT SURGERY

Purpose More than 30 patients presented for reconstruction of penile deformities secondary to penile enlargement surgery performed by other physicians. Lengthening was performed by releasing the suspensory ligament of the penis and advancing pubic skin with a V-Y advancement flap. Girth was increased by injecting autologous fat. Specific complaints relating to the lengthening procedure involve hypertrophic and/or wide scars, a proximal penile hump from a thick, hair-bearing V-Y flap, and a low hanging penis. Complications relating to autologous fat injections include disappearance of fat, penile lumps and nodules, and shaft deformities. The repair of these deformities is described. Materials and Methods From 1994 through October 1996, 19 men underwent 24 various combinations of reconstructive operations, such as scar revisions, V-Y advancement flap reversal, and removal of fat nodules and asymmetrical fat deposits. Results Penile appearance and function were improved. Complications include 1 hematoma requiring drainage, minor wound complications and 1 inadequately reversed V-Y flap. Conclusions The methods of various repairs are discussed, including reconstructive limitations, timing and staging. Significant improvement can be achieved with proper reconstruction of penile deformities.

Complications of Penile Lengthening and Augmentation Seen at 1 Referral Center

Purpose Complications of the recent cosmetic technique of penile lengthening and girth enhancement are reviewed. Materials and Methods During a 16-month period 12 men presented with complications of penile augmentation performed elsewhere. All 12 patients had undergone release of the suspensory ligament and 10 had received autologous fat injection. Results the chief complaint was poor cosmetic appearance (irregular residual fat nodules in 7 men, skin deformity and scarring in 4 and scrotalization in 4). Reoperation was necessary in 6 patients, wound complications occurred in 6 and sexual dysfunction was reported by 4. Only 1 patient reported a subjective increase in penile length. Conclusions Although a verifiable complication rate may never by available, the morbidity of elective penile lengthening and girth enhancement is noteworthy. These cosmetic techniques should be regarded as experimental.

X-RAY SIGN IN WEBER-CHRISTIAN DISEASE.

WEBER-CHRISTIAN DISEASE, more descriptively known as relapsing, febrile, nodular, nonsuppurative panniculitis, is characterized by recurrent tender inflammatory nodules in the subcutaneous fat. Internal fat deposits may also be involved. Many excellent reviews of this syndrome have appeared in the literature in recent years.^1-6It is of interest to note that, in many of the patients described,¹rheumatic fever or some other rheumatic disease had at one time or another been diagnosed. Similarly, for the patient described in this report the diagnosis of rheumatic fever had been made on three widely separate occasions. During a recent episode of panniculitis this patient presented with a severely swollen, red, warm, painful knee. X-rays of the knee revealed changes which we feel are helpful in establishing the diagnosis of Weber-Christian disease. Although x-ray visualization of calcification within the necrotic subcutaneous fat nodules has been described in this condition, we have found no