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== | ==Cellulitis== | ||
===Images=== | ===Images=== | ||
[[File:Cellulitis.png| | [[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 | ||
| Line 20: | Line 20: | ||
*Cobblestone can also be present in: | *Cobblestone can also be present in: | ||
**Lymphedema | **Lymphedema | ||
**Pitting edema | **Pitting edema secondary to HF | ||
==Abscess== | ==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> | 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> | <gallery> | ||
| Line 36: | Line 36: | ||
===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 | ||
| Line 42: | Line 42: | ||
===Findings=== | ===Findings=== | ||
#Positive scan (not all elements are required to make a | #Positive scan (not all elements are required to make a diagnosis) | ||
#*Fluid collect seen has heteroechoic or hypoechoic circular area | #*Fluid collect seen has heteroechoic or hypoechoic circular area | ||
#*Hyperechoic ring | #*Hyperechoic ring | ||
#*Posterior acoustic enhancement | #*Posterior acoustic enhancement | ||
#*Swirling or Squish Sign (movement of abscess debris) with compression | #*Swirling or Squish Sign (movement of [[abscess]] debris) with compression | ||
#*Irregular borders | |||
===Pearls and Pitfalls=== | ===Pearls and Pitfalls=== | ||
| Line 62: | Line 63: | ||
===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 | ||
| Line 78: | Line 79: | ||
*Real-time U/S can aid in FB removal | *Real-time U/S can aid in FB removal | ||
*Water baths may be helpful for extremities | *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 | *Scar tissue may mimic FB | ||
==See Also== | ==See Also== | ||
*[[Ultrasound (Main)]] | |||
*[[Ultrasound: MSK]] | *[[Ultrasound: MSK]] | ||
*[[Incision and Drainage]] | *[[Incision and Drainage]] | ||
| Line 88: | Line 92: | ||
==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