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


CONTRAINDICATIONS



imagesNone


RISKS/CONSENT ISSUES



imagesContact dermatitis from ultrasound gel (very rare)


TECHNIQUE



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


NORMAL SKIN AND SOFT TISSUE (FIGURE 88.1)



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



images


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)


PATHOLOGY



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)



images


FIGURE 88.2 Cellulitis (cobblestone).

Only gold members can continue reading. Log In or Register to continue

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