6 year old girl with a four year history of linear scleroderma of her left arm and hand. Her lesion has extended to her upper back, and she has new lesions on her face and chest. The imaged area is the volar surface of hand above 5th metacarpal bone, which shows chronic atrophy including shortening of this portion of her hand, but no signs of activity. The patient complained of pain in this area. There is abundant color Doppler signal in both the normal and lesion area, but more vascularity is seen in the lesion hypodermis and muscle layers. The lesion hypodermis shows a large area of contiguous color Doppler signal that encompasses at least 20% of the surface area of the imaged hypodermis (hypodermal vascularity = 3). There are 2 large color Doppler signals in the lesion muscle and none in the normal muscle, giving a deep tissue vascularity score of 2. B = bone, D = dermis, H = hypodermis, and M = muscle. Arrowheads indicate boundaries of tissue layers.