Diagnostic ultrasound ( PDFDrive )

874 PART III Small Parts, Carotid Artery, and Peripheral Vessel Sonography
A
B
FIG. 23.35 Forearm Abscess. (A) Short-axis image of a complex luid hypoechoic collection (arrows) with echogenic peripheral soft tissue rind
and increased through transmission, consistent with an abscess. (B) Color Doppler image demonstrates hyperemia within the surrounding soft
tissues. U, Ulna.
Cellulitis may progress to abscess formation. he development
of an associated abscess is an important inding to diagnose, as
this will typically not respond to antibiotics, instead requiring
drainage, either surgical or image guided. Abscesses can have a
variable appearance on ultrasound evaluation. 94 An abscess border
may be well deined or poorly deined and iniltrative (Fig. 23.35).
here may be a surrounding rim of hyperemic, thickened sot
tissue. he internal liqueied material may demonstrate an
anechoic, hypoechoic, or complex echogenic appearance, with
internal septations and low-level echoes. Foci of echogenic gas,
with associated ill-deined shadowing, may be present within
the abscess. With dynamic compression, swirling of the echogenic
debris within the abscess can be seen.
In cases of luid collection, several other entities may be
considered and diferentiated from an abscess. A seroma can be
distinguished from an abscess in that a seroma appears as a
simple anechoic to hypoechoic luid collection without peripheral
hyperemia, and there may be increased through transmission.
A hematoma may appear as a mixed echogenicity luid collection,
yet will have no internal color Doppler low and will have scant
peripheral hyperemia. A sot tissue sarcoma will demonstrate
solid, hyperemic internal components, as well as posterior acoustic
shadowing. If the sonographic diagnosis of the luid collection
is indeterminate, conirmation can be obtained with aspiration
(sonographically guided, if needed) and microbiologic and
histologic assessment of the aspirate.
CONCLUSION
Ultrasound is a cost-efective means by which to provide an
accurate diagnosis in many scenarios of musculoskeletal pathology,
including tendon and ligament injury, arthritis, and characterization
of infection and some sot tissue masses. In addition to
ongoing technical developments, critical to the use of this
technology in the future will be technologist and physician
education and appropriate and consistent incorporation of new
technology into patient care pathways.
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