The Hyperechoic Nodules in Lipedema Are Not All the Same: Description of Criteria and Their Qualitative Patterns
O ultrassom se firmou como ferramenta não invasiva, reprodutível e de baixo custo na avaliação do lipedema, permitindo tanto a medida quantitativa da espessura do subcutâneo quanto a classificação qualitativa LDHC (Lipedema Dermal and Hypodermal Classification).
Os nódulos hiperecoicos já haviam sido descritos e classificados como LDHC 3, e um relato anterior mostrou que sua microscopia revela áreas hemorrágicas e esteatonecrose — consequência da expansão desorganizada da hipoderme, que eleva a pressão no compartimento subcutâneo, gera hipóxia e estimula neovascularização imatura, de parede frágil e propensa a sangrar.
Este trabalho mostra que esses nódulos não são todos iguais e propõe quatro padrões morfológicos: margens mal definidas; margens bem definidas; presença de área anecoica; e sombra acústica posterior tênue. Os autores levantam a possibilidade de que essas apresentações correspondam a estágios evolutivos distintos, o que ainda precisa de correlação com anatomia patológica ou outros métodos.
Referência completa
Foureaux TO, Vargas D, Lellis RF, Chagas LC, Cunha IW, Saiki PY, et al. The hyperechoic nodules in lipedema are not all the same: description of criteria and their qualitative patterns. J Biomed Sci Eng. 2025;18(10):401-7. doi:10.4236/jbise.2025.1810029
Abstract
Lipedema is characterized by symmetrical accumulation of subcutaneous fat in the lower and upper limbs, sparing the trunk, feet and hands. Although diagnosis is primarily clinical, ultrasound has proven to be a valuable, non-invasive, reproducible, and cost-effective tool for the assessment of lipedema. Ultrasound (US) facilitates diagnosis through quantitative evaluation of subcutaneous tissue thickness and enables qualitative Lipedema Dermal and Hypodermal Classification (LDHC), with morphological changes. The presence of hyperechoic nodules in patients with lipedema has been previously described and classified as LDHC 3; recently, a case report analyzing the microscopic features of such nodules demonstrated hemorrhagic areas and steatonecrosis, resulting from disorganized hypodermal expansion leading to increased pressure within the subcutaneous compartment—causing hypoxia and stimulating immature neovascularization (fragile wall, predisposing to hemorrhage). However, these nodules are not uniform and exhibit different morphologies, enabling subclassification. The first type presents with poorly defined margins; the second is well-defined margins; the third has an anechoic area, and the fourth shows a faint posterior shadow. These different nodule presentations in lipedema may be correlated with evolutionary stages or previously described clinical presentations, requiring future correlation with pathological anatomy or other diagnostic methods.
Original abstract as published in Journal of Biomedical Science and Engineering.