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Skin and Soft Tissue Ultrasound

  • Angela Bray CredittEmail author
  • Michael Joyce
  • Jordan Tozer
Chapter
  • 1.2k Downloads

Abstract

Ultrasonography is routinely used for the evaluation of skin and soft tissue complaints. It is relatively easy to perform due to the superficial location of each structure allowing for high-frequency imaging, thereby producing high-resolution, detailed images. Commonly, ultrasound is used to evaluate for abscess, cellulitis, and foreign bodies within the skin and soft tissue. Recently, evidence demonstrates that ultrasound is becoming more useful and efficient in the diagnosis of necrotizing fasciitis, a life-threatening condition that requires timely recognition. This chapter will review basic skin and soft tissue anatomy, image acquisition, normal ultrasound anatomy, and interpretation of pathology.

Keywords

Cellulitis Abscess Hematoma Necrotizing fasciitis Foreign body Lymph node 

Supplementary material

Video 15.1

Normal skin and soft tissue ultrasound. Soft tissue layers from superficial to deep include: epidermis, dermis, subcutaneous tissue (hypodermis), fascia, muscle, bone (MP4 629 kb)

Video 15.2

Cellulitis. Cellulitis typically appears as cobblestoning of the subcutaneous tissue with associated thickening of the dermal layers (MP4 2251 kb)

Video 15.3

Cellulitis with increased tissue edema. Note cobblestoning with increased anechoic areas due to severe cellulitis and/or concomitant tissue edema of other etiology (MP4 2160 kb)

Video 15.4

Abscess. Hypoechoic fluid collection with internal echogenic debris representing an abscess (MP4 2040 kb)

Video 15.5

Abscess with internal swirling from compression. With compression by the transducer, internal swirling of abscess contents will occur. This can help distinguish an abscess from other etiologies such as a lymph node (MP4 2024 kb)

Video 15.6

Necrotizing fasciitis with perifascial fluid. Fluid tracking along the fascial plane with thickened subcutaneous tissue and a loss of normal architecture. Perifascial fluid greater than 4 mm likely indicates a diagnosis of necrotizing fasciitis (MP4 2279 kb)

Video 15.7

Hematoma. Hypoechoic fluid collection representing abdominal hematoma. On ultrasound, may be indistinguishable from abscess (MP4 473 kb)

Video 15.8

Metal foreign body in long axis. Brightly echogenic foreign body represents a broken needle within the neck of a patient from intravenous drug abuse (MP4 1940 kb)

Video 15.9

Metal foreign body in short axis. Brightly echogenic foreign body represents a broken needle within the neck of a patient from intravenous drug abuse (MP4 2110 kb)

Video 15.10

Lymph node. Lymph node with hyperechoic medulla surrounded by hypoechoic cortex. Also imaged are two vascular structures that are more round and anechoic when compared with a lymph node (MP4 2174 kb)

References

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    SonoSim Ultrasound Training Solution [Video]. Santa Monica, CA: SonoSim Inc.; 2017.Google Scholar
  2. 2.
    Dewitz A. Chapter 18: Musculoskeletal, soft tissue, and miscellaneous applications. In: Ma OJ, Mateer JR, Reardon RF, Joing SA, editors. Emergency ultrasound. 3rd ed. New York: McGraw-Hill Education; 2014. p. 503–68.Google Scholar
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    Yen Z, Wang H, Ma H, Chen S, Chen W. Ultrasonographic screening of clinically-suspected necrotizing fasciitis. Acad Emerg Med 2002; 9(12):1448–1451. http://onlinelibrary.wiley.com/doi/10.1197/aemj.9.12.1448/epdf. Accessed 17 Apr 2017.
  4. 4.
    Wronski M, Slodkowski M, Cebulski W, Karkocha D, Krasnodebski I. Necrotizing fasciitis: early sonographic diagnosis. J Clin Ultrasound 2011; 39(4)236–239. http://edus.ucsf.edu/sites/edus.ucsf.edu/files/wysiwyg/Necrotizing%20fasciitis%3A%20Early%20sonographic%20diagnosis.pdf. Accessed 17 Apr 2017.
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    Jacobson JA. Chapter 6: Hip and thigh ultrasound. In: Jacobson JA, editor. Fundamentals of musculoskeletal ultrasound. 2nd ed. Philadelphia, PA: Sanders; 2013. p. 162–211.Google Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Angela Bray Creditt
    • 1
    Email author
  • Michael Joyce
    • 1
  • Jordan Tozer
    • 1
  1. 1.Department of Emergency MedicineVirginia Commonwealth University Medical CenterRichmondUSA

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