View source for Ultrasound: Soft tissue

==Background==
{{Skin anatomy background images}}
*Soft tissue ultrasound can help with differentiating [[abscess]] from cellulitis
*Many types of foreign bodies can be visualized

==Cellulitis==
===Images===
[[File:Cellulitis.png|300px|Cellulitis and cobblestoning]]

===Instructions===
#Select linear probe (high frequency probe)
#Scan area of concern (orientation of probe not as important)
#Rotate 90° over area of concern

===Findings===
*Positive
**Cobblestoning - thin lines of fluid between fat globules
**Loss of tissue plain definition

===Pearls and Pitfalls===
*Cobblestone can also be present in:
**Lymphedema
**Pitting edema secondary to HF

==Abscess==
Novice sonographers can predict a positive I&D with SN 0.97 and SP 0.67 (vs clinical exam 0.76 and 0.83)<ref>Berger, T, et al. Bedside ultrasound performed by novices for the detection of [[abscess]] in ED patients with soft tissue infections. Am J Emerg Med. 2012; 30(8):1569-73. doi: 10.1016/j.ajem.2011.08.002.</ref>
===Images===
<gallery>
File:Gas gangrene.png|Gas gangrene
File:Isoechoic abscess.png|Abscess
</gallery>

<gallery>
File:Hematoma 2.png|Hematoma
File:Hematoma.png|Hematoma
</gallery>

===Instructions===
#Select linear probe (high frequency probe)
#Scan area of concern (orientation of probe not as important)
#Rotate 90° over area of concern
#If hypoechoic area is identified, apply gentle pressure over area

===Findings===
#Positive scan (not all elements are required to make a diagnosis)
#*Fluid collect seen has heteroechoic or hypoechoic circular area
#*Hyperechoic ring
#*Posterior acoustic enhancement
#*Swirling or Squish Sign (movement of [[abscess]] debris) with compression
#*Irregular borders

===Pearls and Pitfalls===
*Color flow may be used to differentiate vascular and lymphatic structures
*In the inguinal crease strangulated bowel can mimic abscess
*The collection seen under U/S may not correspond with actual collection size
*Hematomas can look similar to abscess, so the right clinical context is needed

==Foreign Body==
===Images===
<gallery>
File:Foreign body in finger.png|Foreign body in finger
File:Needle tip in muscle tissue.png|Needle tip in muscle
</gallery>

===Instructions===
#Select linear probe (high frequency probe)
#Scan area of concern (orientation of probe not as important)
#Rotate 90° over area of concern

===Findings===
*FB can show 2 different signs
**Acoustic shadow - Ring down appearance
***Common with wood and splinters
**Reverberation
***Common with metal such are retained insulin needle

===Pearls and Pitfalls===
*U/S is no sensitive for FB (U/S will miss a substantial amount of FBs)
**Xray or other modality may be needed for look during negative exams
*Real-time U/S can aid in FB removal
*Water baths may be helpful for extremities
**Place extremity in water bath and place ultrasound probe in water over area of concern
***Does not require ultrasound probe to touch painful area but still allows good visualization 
*Scar tissue may mimic FB

==See Also==
*[[Ultrasound (Main)]]
*[[Ultrasound: MSK]]
*[[Incision and Drainage]]
*[[Cellulitis]]
*[[Soft Tissue Foreign Body]]

==External Links==

==References==
<references/>

[[Category:Radiology]]
[[Category:Dermatology]]
[[Category:ID]]