Friday, November 02, 2012

Sonography first for subcutaneous abscess and cellulitis evaluation.

Sonography first for subcutaneous abscess and cellulitis evaluation.

Oct 2012

  1. Michael Blaivas, MD
  1. Author Affiliations
    1. Department of Emergency Medicine, University of Arizona Medical School, Tucson, Arizona USA (S.A.); and Department of Emergency Medicine, Northside Hospital Forsyth, Cumming, Georgia USA (M.B.).
    1. Address correspondence to Michael Blaivas, MD, Department of Emergency Medicine, Northside Hospital Forsyth, 1200 Northside Forsyth Dr, Cumming, GA 30040-1147 USA.
    Sonography is an ideal imaging modality for evaluation of pathologic soft tissue conditions. High resolution and the ability to perform dynamic testing such as compressing structures allow for accurate differentiation between potentially confusing physical findings. Traditionally, clinicians assumed that any area of the skin that was erythematous and showed swelling potentially harbored an abscess. Incision and drainage has long been the standard of care in such cases and was often used as a diagnostic procedure. However, studies have confirmed anecdotal clinical evidence that the physical examination is often incorrect. In fact, not only was incision and drainage being performed unnecessarily, in some cases, needed procedures were missed after failure to recognize the presence of an abscess. With the recent spread of sonography into clinical practice, multiple descriptions of point-of-care sonography use in suspected soft tissue infections have been published. Some have even noted that blind incision and drainage, once thought to be harmless, could lead to serious potential complications because not all red swollen structures should be cut with a scalpel. This article reviews clinical scenarios in which point-of-care soft tissue sonography is useful in suspected skin infections and describes pathologic findings and commonly accepted scanning approaches.

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