Incidental findings of clinical relevance
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Wien Klin Wochenschr https://doi.org/10.1007/s00508-020-01788-6
Incidental findings of clinical relevance Bernhard Michael Trabauer
· Kyra Szag · Wolfgang Krampla
Received: 2 July 2020 / Accepted: 25 November 2020 © Springer-Verlag GmbH Austria, part of Springer Nature 2020
A 70-year-old patient presented to the traumatology department after he fell down the stairs. As an incidental finding the computed tomography (CT) scan showed bilateral, periumbilical subcutaneous alterations. These appeared to be soft tissue transformations with calcified sections, measuring approximately 4 cm (Fig. 1). The past medical history was evaluated in detail. The patient has been suffering from type 1 diabetes for 60 years with numerous episodes of hypoglycemia and hyperglycemia. According to the patient the last measured glycated hemoglobin (HbA1c) level was 8.1%. The patient admitted to injecting the insulin in the same area for multiple years, which ultimately caused the radiologically proven alterations. The findings from the CT scan were interpreted as insulin-induced lipohypertrophy. This led to an modification of the insulin application. The patient was trained to alternate the injection spots. These multiple modifications led to a drop of the glycemic blood level within days. (Fig. 2). Lipohypertrophy is a well-known negative side effect of subcutaneous, antidiabetic therapy. This letter to the editors shows the possibility of diagnosing lipohypertrophic changes with the help of CT. This pathology can be considered as a main reason for delayed and unpredictable release of the injected insulin. Functionally this leads to variably elusive blood glucose levels. Morphologically it leads to an enlargement of adipocytes or induration of fat tissue is described [1].
Fig. 1
CT scan, zoomed abdominal wall
Dr. B. M. Trabauer, BSC () · Dr. K. Szag · Prim. Priv.-Doz. Dr. W. Krampla, MBA Landesklinikum Korneuburg-Stockerau, Austria [email protected]
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Incidental findings of clinical relevance
letter to the editors
Fig. 2 Glycemic blood levels and trend line
Established classifications refer to sonographic findings in the literature [2–4]. The appearance of subcutaneous CT findings is barely described and is not common knowledge among radiologists. Kamaya et al. even said that these findings can mimic the presence of a liposarcoma [5]. Conflict of interest B.M. Trabauer, K. Szag, and W. Krampla declare that they have no competing interests.
References 1. Oriot P, Hermans MP. Lipohypertrophy effect on glycemic profile in an adult with type 1 diabetes using scanned continuous glucose monitoring. J Diabetes Sci Technol. 2019;14(2):500–1. https://doi.org/10.1177/19322968198 88213.
Incidental findings of clinical relevance
2. Bertuzzi F, Meneghini E, Bruschi E, Luzi L, Nichelatti M, Epis O. Ultrasound characterization of insulin induced lipohypertrophy in type 1 diabetes mellitus. J Endocrinol Invest. 2017;40(10):1107–13. https://doi.org/10.1007/ s40618-017-0675-1. 3. Perciun R. Ultrasonographic aspect of subcutaneous
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