26 - Soft Tissue Ultrasound

Summary

The use of ultrasound in the evaluation of soft tissue structures has many potential applications. When used judiciously, soft tissue ultrasound may improve the clinician's diagnostic accuracy, result in more appropriate treatment, and improve patient comfort during diagnostic and therapeutic procedures. This modality serves as an extension to the clinician's physical exam and allows real-time visualization during procedures without the use of ionizing radiation. The role for ultrasound in disease states involving the soft tissues continues to expand with the increased utilization of bedside ultrasound in emergency medicine. This chapter focuses on three indications well documented in the literature: soft tissue infections, foreign bodies, and peritonsillar abscesses.

SKIN AND SOFT TISSUE INFECTIONS

Indications

The patient presenting with signs or symptoms consistent with a soft tissue infection requires accurate diagnosis to facilitate appropriate management. Clinicians across disciplines are evaluating an increasing number of soft tissue infections, particularly those associated with community-acquired methicillinresistant Staphylococcus aureus (1–3). Traditionally, the findings on physical examination of fluctuance or protuberant swelling were sought as indicators of a cutaneous abscess. In equivocal cases, needle aspirates could be employed to identify areas containing purulent collections. However, the use of ultrasound provides a noninvasive tool to distinguish between cellulitis and abscess.