Ultrasound: Soft tissue: Difference between revisions
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==Background== | ==Background== | ||
*Soft tissue | *Soft tissue ultrasound can help with differentiating [[abscess]] from cellulitis | ||
*Many types of foreign bodies can be visualized | *Many types of foreign bodies can be visualized | ||
== | ==Cellulitis== | ||
===Images=== | ===Images=== | ||
[[File:Cellulitis.png|300px|Cellulitis and cobblestoning]] | |||
===Instructions=== | ===Instructions=== | ||
#Select linear probe (high | #Select linear probe (high frequency probe) | ||
#Scan area of concern (orientation of probe not as important) | #Scan area of concern (orientation of probe not as important) | ||
#Rotate 90° over area of concern | #Rotate 90° over area of concern | ||
===Findings=== | ===Findings=== | ||
*Positive | |||
**Cobblestoning - thin lines of fluid between fat globules | |||
**Loss of tissue plain definition | |||
===Pearls and Pitfalls=== | |||
*Cobblestone can also be present in: | |||
**Lymphedema | |||
**Pitting edema secondary to HF | |||
== | ==Abscess== | ||
Novice sonographers can predict a positive I&D with SN 0.97 and SP 0.67 (vs clinical exam 0.76 and 0.83)<ref>Berger, T, et al. Bedside ultrasound performed by novices for the detection of [[abscess]] in ED patients with soft tissue infections. Am J Emerg Med. 2012; 30(8):1569-73. doi: 10.1016/j.ajem.2011.08.002.</ref> | |||
===Images=== | ===Images=== | ||
<gallery> | |||
File:Gas gangrene.png|Gas gangrene | |||
File:Isoechoic abscess.png|Abscess | |||
</gallery> | |||
<gallery> | |||
File:Hematoma 2.png|Hematoma | |||
File:Hematoma.png|Hematoma | |||
</gallery> | |||
===Instructions=== | ===Instructions=== | ||
#Select linear probe (high | #Select linear probe (high frequency probe) | ||
#Scan area of concern (orientation of probe not as important) | #Scan area of concern (orientation of probe not as important) | ||
#Rotate 90° over area of concern | #Rotate 90° over area of concern | ||
#If hypoechoic area is identified, apply gentle pressure over area | |||
===Findings=== | ===Findings=== | ||
#Positive scan (not all elements are required to make a diagnosis) | |||
#*Fluid collect seen has heteroechoic or hypoechoic circular area | |||
#*Hyperechoic ring | |||
#*Posterior acoustic enhancement | |||
#*Swirling or Squish Sign (movement of [[abscess]] debris) with compression | |||
#*Irregular borders | |||
===Pearls and Pitfalls=== | |||
*Color flow may be used to differentiate vascular and lymphatic structures | |||
*In the inguinal crease strangulated bowel can mimic abscess | |||
*The collection seen under U/S may not correspond with actual collection size | |||
*Hematomas can look similar to abscess, so the right clinical context is needed | |||
==Foreign Body== | ==Foreign Body== | ||
===Images=== | ===Images=== | ||
<gallery> | |||
File:Foreign body in finger.png|Foreign body in finger | |||
File:Needle tip in muscle tissue.png|Needle tip in muscle | |||
</gallery> | |||
===Instructions=== | ===Instructions=== | ||
#Select linear probe (high frequency probe) | |||
#Scan area of concern (orientation of probe not as important) | |||
#Rotate 90° over area of concern | |||
===Findings=== | ===Findings=== | ||
*FB can show 2 different signs | |||
**Acoustic shadow - Ring down appearance | |||
***Common with wood and splinters | |||
**Reverberation | |||
***Common with metal such are retained insulin needle | |||
===Pearls and Pitfalls=== | |||
*U/S is no sensitive for FB (U/S will miss a substantial amount of FBs) | |||
**Xray or other modality may be needed for look during negative exams | |||
*Real-time U/S can aid in FB removal | |||
*Water baths may be helpful for extremities | |||
**Place extremity in water bath and place ultrasound probe in water over area of concern | |||
***Does not require ultrasound probe to touch painful area but still allows good visualization | |||
*Scar tissue may mimic FB | |||
==See Also== | |||
*[[Ultrasound (Main)]] | |||
*[[Ultrasound: MSK]] | |||
*[[Incision and Drainage]] | |||
*[[Cellulitis]] | |||
*[[Soft Tissue Foreign Body]] | |||
==External Links== | ==External Links== | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:Radiology]] | |||
[[Category:Dermatology]] | |||
[[Category:ID]] | |||
Latest revision as of 18:11, 10 April 2020
Background
- Soft tissue ultrasound can help with differentiating abscess from cellulitis
- Many types of foreign bodies can be visualized
Cellulitis
Images
Instructions
- Select linear probe (high frequency probe)
- Scan area of concern (orientation of probe not as important)
- Rotate 90° over area of concern
Findings
- Positive
- Cobblestoning - thin lines of fluid between fat globules
- Loss of tissue plain definition
Pearls and Pitfalls
- Cobblestone can also be present in:
- Lymphedema
- Pitting edema secondary to HF
Abscess
Novice sonographers can predict a positive I&D with SN 0.97 and SP 0.67 (vs clinical exam 0.76 and 0.83)[1]
Images
Gas gangrene
Abscess
Hematoma
Hematoma
Instructions
- Select linear probe (high frequency probe)
- Scan area of concern (orientation of probe not as important)
- Rotate 90° over area of concern
- If hypoechoic area is identified, apply gentle pressure over area
Findings
- Positive scan (not all elements are required to make a diagnosis)
- Fluid collect seen has heteroechoic or hypoechoic circular area
- Hyperechoic ring
- Posterior acoustic enhancement
- Swirling or Squish Sign (movement of abscess debris) with compression
- Irregular borders
Pearls and Pitfalls
- Color flow may be used to differentiate vascular and lymphatic structures
- In the inguinal crease strangulated bowel can mimic abscess
- The collection seen under U/S may not correspond with actual collection size
- Hematomas can look similar to abscess, so the right clinical context is needed
Foreign Body
Images
Foreign body in finger
Needle tip in muscle
Instructions
- Select linear probe (high frequency probe)
- Scan area of concern (orientation of probe not as important)
- Rotate 90° over area of concern
Findings
- FB can show 2 different signs
- Acoustic shadow - Ring down appearance
- Common with wood and splinters
- Reverberation
- Common with metal such are retained insulin needle
- Acoustic shadow - Ring down appearance
Pearls and Pitfalls
- U/S is no sensitive for FB (U/S will miss a substantial amount of FBs)
- Xray or other modality may be needed for look during negative exams
- Real-time U/S can aid in FB removal
- Water baths may be helpful for extremities
- Place extremity in water bath and place ultrasound probe in water over area of concern
- Does not require ultrasound probe to touch painful area but still allows good visualization
- Place extremity in water bath and place ultrasound probe in water over area of concern
- Scar tissue may mimic FB