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KEY IMAGES

Normal

Abscess

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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.

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Cellulitis with “cobblestoning”

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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.

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Air present in fascia

Measuring the abscess

Color Doppler image

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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.

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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 the size ...

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