Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ KEY IMAGES +++ Normal ++ Figure 13-1 Graphic Jump LocationView Full Size||Download Slide (.ppt) +++ Abscess ++ Vedio Graphic Jump Location Video 13-01: Abscess An abscess demonstrates several signs, including an irregular border, posterior acoustic enhancement and pusistalsis. This video of an abscess shows an operator using a very light touch with the transducer while sliding over the abcess. The echogenic material inside the abscess is pus without any air artifacts. A vessel can be seen branching deep to the abscess which is important to note prior to intervention. This technique can be used to measure the size and depth of the abscess. Play Video +++ Cellulitis with “cobblestoning” ++ Vedio Graphic Jump Location Video 13-02: Cellulitis In cellulitis, the inflammation results in anechoic fluid interdigitating through the subcutaneous fat, creating the cobblestoned appearance of this video. The thickened dermis is also notable. Differentiating cellulitis from chronic edema, however, is still not a simple ultrasound technique. Play Video +++ Air present in fascia ++ Figure 13-2 Graphic Jump LocationView Full Size||Download Slide (.ppt) +++ Measuring the abscess ++ Figure 13-3 Graphic Jump LocationView Full Size||Download Slide (.ppt) +++ Color Doppler image ++ Vedio Graphic Jump Location Video 13-03: Abscess with color Doppler Use of color Doppler allows visualization of vascular structures near an abscess. The abscess itself should have no flow fast enough to cause a color signal. This abscess, however, has a vessel running through the center of it that would have otherwise been missed. Play Video +++ ACQUISITION TIPS ++ Indications: Evidence of tissue infection, soft-tissue swelling, erythema, tenderness, or fluctuance. Except for very high BMI patients or when scanning the gluteal region, use a high-frequency linear probe. Use a probe cover if there is any concern for drainage from the lesion. A dedicated probe cover or an exam glove can be used to cover the probe. Apply gel both inside and outside the glove. Start the scan over unaffected skin first and identify the anchoring anatomy: Most soft tissue infections are in the dermis, so the most important piece of anchoring anatomy is the superficial fascia of the muscle. Start the scan away from the affected area to gain trust and assessment of normal anatomy and work toward the lesion. Scan the affected area in two orthogonal planes and obtain clips/still images. Keep the gain low and the depth deep enough to see the underlying fascial plane. Use color Doppler to assess for vascularity/hyperemia and record findings. Measure the lesion in three axes (length × width × height) and consider measuring skin surface to fluid pocket to guide a drainage procedure. Documenting ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.