Kimura's disease of the elbows

Kimura's disease: effects of age on clinical presentation

BACKGROUND

Kimura's disease (KD) is known to be dominant among young Asian men, but it can also occur in middle- and advanced-aged people. The clinical characteristics of KD, especially by age, are not well known.

AIM

This study was performed to investigate the effects of age on the clinical characteristics of KD.

DESIGN

We conducted a case series study.

METHODS

All case studies of patients diagnosed with KD were collected via a PubMed search of studies published until August 2018. The data were analyzed by age group.

RESULTS

In total, 215 studies were reviewed (238 patients; mean age of 36 years). The male:female ratio was 4:1 overall, 17:1 in patients aged <20 years, 4:1 in patients aged 20-39 years and 2:1 in patients aged ≥40 years (P = 0.01). The percentage of patients with pruritus was 15.4% overall, 3.8% in patients aged <20 years, 15.5% in patients aged 20-39 years and 21.7% in patients aged ≥40 years (P = 0.02). The time to diagnosis was 5.3 years overall, 3.2 years in patients aged <20 years, 4.7 years in patients aged 20-39 years and 7.1 years in patients aged ≥40 years (P < 0.01).

CONCLUSIONS

The proportion of female patients affected the incidence of pruritus, and the time to diagnosis increased as the patients' age increased. There were no significant age-related differences in region/race, complications, multiplicity, laterality, anatomical distribution, maximum size, eosinophil count, immunoglobulin E level, initial treatment, recurrence or outcomes. This may be useful information for the diagnosis of KD.

Clinical significance and epidemiological evolution of epitrochlear lymphadenopathy in pre- and post-highly active antiretroviral therapy era: A systematic review of the literature

Epitrochlear lymphadenopathy is believed to be associated with distinct etiologies, however the evidence for the same is lacking. We systematically reviewed the reported causes of an enlarged epitrochlear lymph node and compared them over different time periods. Epitrochlear lymphadenopathy was encountered in a wide range of diseases, and we found no association with any particular disease.

Epitrochlear cat scratch disease: unique imaging features allowing differentiation from other soft tissue masses of the medial arm

OBJECTIVE

Evaluate anatomic and imaging features of epitrochlear regional adenopathy secondary to cat scratch disease (CSD) to assist differentiation of CSD from other soft tissue masses at the elbow.

MATERIALS AND METHODS

Retrospective review of 24 confirmed cases of CSD. Patient demographics, clinical presentation and radiographic (R; n = 10), CT (n = 3), ultrasound (US; n = 5), and MR (n = 21) images were reviewed. Lesion location, size, number of masses, and intrinsic characteristics on R/CT/US/MR and presence of soft tissue inflammatory changes or adjacent bone or joint involvement were established through the consensus interpretation by four musculoskeletal radiologists.

RESULTS

The average patient age was 18.6 years. Mass location was anterior and superficial to the medial intermuscular septum (100 %) with the masses posterior or posteromedial to the basilic vein (92 %). Three or fewer lymph nodes were involved in 92 %. Masses were noncalcified with adjacent inflammatory change (R = 90 %, CT = 100 %). US showed hypoechoic soft tissue echogenicity masses with defined to minimally irregular margins (80 %) and preserved central hilar hypervascularity on Doppler (100 % of cases). On MR, masses were T1 isointense (62 %), T2 isointense (54 %), intermediate signal on T2 images with fat suppression (55 %), and had perilesional inflammatory changes (95 %), perilesional fluid collections (38 %), adjacent muscle edema (81 %), hyperintense cental hilar vascular enhancement (65 %) and occasional preserved central hilar fat (14 %).

CONCLUSION

Cat scratch disease is suggested by the characteristic location of a medial epitrochlear mass superficial to the brachial fascia and posterior to the basilic vein with surrounding inflammatory changes and preservation of hilar vascular architecture, hilar enhancement and occasional hilar fat.

A rare disease in an atypical location-Kimura's Disease of the upper extremity

Kimura's disease is a rare chronic inflammatory disorder predominantly affecting young Asian male patients, occurring mainly in the head and neck regions. Kimura's disease of the upper extremity is extremely rare, and previous case reports in the literature show similar imaging characteristics with consistent location at the medial epitrochlear region, predominantly with unilateral involvement. We present the first reported case of Kimura's disease affecting the anterolateral aspect of the upper arm, sparing the medial epitrochlear region, illustrating that with typical MR appearance and serology, the involvement of this rare disease in an atypical location still warrants consideration of this diagnosis. There was also bilateral asymmetrical involvement in our patient, suggesting the possibility of a propensity for Kimura's disease affecting the upper extremities to have bilateral involvement, which may necessitate imaging of the clinically asymptomatic contralateral limb in these patients for early lesion identification and treatment.

Ultrasonographic findings of Kimura's disease presenting in the upper extremities

OBJECTIVE

To describe ultrasound findings of Kimura's disease arising in the upper extremities.

MATERIALS AND METHODS

Five patients with Kimura's disease confirmed by surgical resection were retrospectively reviewed by two musculoskeletal radiologists and a pathologist.

RESULTS

All six lesions involved the epitrochlear area and appeared as partially (n = 5) or poorly (n = 1) marginated subcutaneous masses with the presence of curvilinear hyperechoic bands intermingled within the hypoechoic components by US. Moderate (n = 4) to severe (n = 2) vascular signals were observed in some proportion of the hyperechoic bands by color Doppler US. The associated findings were the increased echogenicity of surrounding subcutaneous fat (n = 6) and adjacent lymphadenopathy (n = 4). Microscopic examination showed proliferation of lymphoid follicles with prominent germinal centers and intervening fibrosis.

CONCLUSIONS

In this study, Kimura's disease arising in the upper extremities showed a partially defined hypoechoic subcutaneous mass with internal hyperechoic bands and moderate-to-severe vascularities, increased echogenicity of the surrounding subcutaneous fat and adjacent lymphadenopathy on US. Thus, when these US features are observed in the typical epitrochlear region of an Asian individual, especially if accompanied by peripheral eosinophilia, Kimura's disease should be considered as a possible diagnosis.

Bilateral asymmetric superficial soft tissue masses with extensive involvement of both upper extremities: demonstration of Kimura's disease by US and MRI (2008: 12b)

Kimura's disease is known as a rare chronic inflammatory disease occurring mainly in the head and neck regions of Asian male patients. We present a case of Kimura's disease with extensive involvement of the bilateral upper extremities in a 20-year-old Korean man. Ultrasonography (US) and magnetic resonance imaging (MRI) demonstrated the presence of partially ill-defined, conglomerated soft tissue masses centered in the subcutaneous layer of both upper arms, with cranial extension along the cutaneous nerve in the right lesion. Medial epitrochlear, axillary and lower cervical lymphadenopathy accompanied the masses.