Skin and Soft-Tissue Ultrasound

imagesIdentify and differentiate cellulitis from abscess with overlying cellulitis

imagesProcedural guidance for incision and drainage of abscess

imagesAssess soft-tissue masses




imagesContact dermatitis from ultrasound gel (very rare)


imagesLinear transducer (7.5–10+ MHz)

imagesSonographic grip—always have part of the hand, i.e., the little finger, resting upon the body of the patient when possible, as this helps stabilize the probe for fine movements

imagesReduce depth

imagesAdjust gain using a fluid-filled structure as the standard (anechoic fluid or blood should be crisply anechoic)

imagesCaliper function can be used to measure abscesses in two or three planes

imagesAssess for vascularity using color Doppler, as the presence of vascularity may result in a contraindication to incision and drainage


imagesAdjust depth to focus only on region of interest, typically 2 to 4 cm

imagesScan a wide region, starting away from the region of interest to assess presumably normal skin and soft tissue


FIGURE 88.1 Normal (vessel, LN, muscle, skin/soft tissue).

imagesBe familiar with the appearance of soft tissue and the structures within it (skin, subcutaneous tissue, blood vessels, lymph node, nerve, muscle fascicles, tendon, bone)


imagesCellulitis (FIGURE 88.2)

   imagesDiffuse thickened (slightly hyperechoic) subcutaneous layer and fluid (anechoic) dissecting the deeper layers of the skin and fat, creating the pathognomonic cobblestone appearance

   imagesCan see thin hyperechogenic transverse layers between layers of normal dermis

   imagesPosterior acoustic enhancement

imagesAbscess (FIGURES 88.388.5)

   imagesVariable appearance on ultrasound

   imagesTypically see well-defined border, but possibly irregular

   imagesMay see anechoic fluid-filled pocket with or without septae supporting loculation (debris)

   imagesMay see posterior acoustic enhancement (shadowing)


FIGURE 88.2 Cellulitis (cobblestone).

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Skin and Soft-Tissue Ultrasound
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