POCUS - Soft Tissue Flashcards
Abscess evaluations should be done with what transducer?
Linear 5-10 MHz
Why should you use plenty of gel in evaluating an abscess?
The person may be tender and the use of copious gel means less pressure.
Water bath is also an option if the area is in an extremity.
Cover the transducer if ___________ is present.
drainage
Cellulitis will always appear ____________ to the fascial layer.
superficial
If the cobblestoning is deeper than the fascia then necrotizing fasciitis may be present.
What can cause the cobblestoning appearance that is seen in cellulitis US?
Edema or any kind of inflammation
For this reason, US should not be used to diagnose cellulitis. For instance, when patients have lymphedema they will have cobblestoning all the time. US showing cobblestoning would not indicate cellulitis.
Be sure that you can see the ____________ in abscesses.
the base
If the base extends out of view then it suggests a deeper abscess that needs more advanced imaging.
What might you see within an abscess?
With compression, you can see swirling of hyperechoic material in the fluid.
You can also see loculations.
If you see hyperechoic material with posterior shadowing within an abscess, then you may be seeing ____________.
gas
Consider a gas-forming infection, particularly if the wound or the patient look bad.
What thing can look like an abscess on POCUS?
Hematoma
In fact, they can be indistinguishable on POCUS. Both are irregular, contained masses in soft tissue that compress partially, have swirling internal contents, and do not have blood flow. Clinically correlate.
Lymph nodes can also look like abscesses, particularly if the are necrotic. Lymph nodes may be distinguishable with flow, though.
To perform the peritonsillar scan, use the ___________ probe with the indicator pointed toward the patient’s ____________.
endocavitary; right
What things do you need to consider when evaluating a patient for a peritonsillar abscess?
Mimicking DDX on exam:
- Carotid artery aneurysm (will have pulsatile flow on POCUS)
- Cyst (may appear rounder on POCUS)
- Hematoma
- Cancer (will not be compressible or anechoic on POCUS)
Baker’s cysts originate from where?
The posterior bursa of the knee
What is the beak sign?
Baker’s cysts will be anechoic structures that have a tapered point on the deep edge. This is where the cyst connects with the bursa.
What foreign bodies can be missed on XR?
Wood, plastic, and thorns
What is the sensitivity of US detecting wood and plastic foreign bodies?
Wood: 93%
Plastic: 73%
