Skin and Soft Tissue Ultrasound



Figure 15.1
Water bath positioning. To facilitate visualization of small parts, have the patient place the affected area in a container of water, and hover the probe over the area of interest



A426434_1_En_15_Fig2_HTML.jpg


Figure 15.2
Water bath ultrasound. Dorsal hand ultrasound using a water bath showing separation of transducer from the tissue of interest


A426434_1_En_15_Fig3_HTML.jpg


Figure 15.3
Soft tissue layers. Soft tissue layers identified from superficial to deep including epidermis, dermis, subcutaneous tissue (hypodermis), fascia, muscle, bone




Skin and Soft Tissue Pathology






  • Cellulitis



    • Disruption of the skin with invasion of bacteria causing an infection of the dermis and subcutaneous fat.


    • Cellulitis can be identified by increased echogenicity and thickening of the subcutaneous tissue with hyperechoic areas of inflamed soft tissue outlined by hypoechoic fluid between these areas [1, 2]:



      • This is referred to as cobblestoning [1].


      • These findings are due to the accumulation of subcutaneous edema.


    • Figure 15.4—Cellulitis.


    • Video 15.2—Cellulitis.


    • Figure 15.5—Cellulitis with increased soft tissue edema.


    • Video 15.3—Cellulitis with increased soft tissue edema.


  • Abscess



    • Walled off bacterial infection resulting in a collection of purulent fluid.


    • Will be identified as a hypoechoic fluid collection containing debris [1] with irregular borders and the absence of posterior enhancement:



      • Figure 15.6—Abscess


      • Video 15.4—Abscess


    • Internal swirling of the fluid will typically occur with compression and can help distinguish fluid-filled collection from solid mass:



      • Video 15.5—Abscess with internal swirling from compression


    • There will be an absence of internal Doppler flow.


    • Air in the abscess cavity is significant for gas-forming organisms and will need emergent treatment:



      • This can be identified as echogenic areas within the abscess cavity [2] with dirty posterior shadowing and posterior reverberations.


  • Necrotizing Fasciitis

Feb 27, 2018 | Posted by in ULTRASONOGRAPHY | Comments Off on Skin and Soft Tissue Ultrasound
Premium Wordpress Themes by UFO Themes