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Age: 22

Sex: Female

Indication: Abdominal wall cellulitis

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Case #21


Findings

  • Hypoechoic collection with a thick, lobulated wall in the lower ventral abdominal wall along the right aspect of the mons pubis measuring 1.7 x 3.5 x 5 cm with its superficial margin less than 0.5 cm deep to the skin surface
  • Surrounding increased vascularity without evidence of internal vascularity
  • Surrounding skin thickening and subcutaneous edema


Diagnosis

Soft tissue abscess

Sample Report

Hypoechoic, avascular collection consistent with an abscess in the lower ventral abdominal wall along the right aspect of the mons pubis. This collection measures 1.7 x 3.5 x 5 cm with its superficial margin less than 0.5 cm deep to the skin surface.

Surrounding skin thickening, subcutaneous edema, and increased vascularity, which can be seen with cellulitis.


Discussion

  • Ultrasound is commonly used in the evaluation of soft tissue infections
  • While cellulitis is a clinical diagnosis, the findings of skin thickening, subcutaneous edema, and increased vascularity are supportive
  • When assessing these patients, look for complicating features including:
    • Abscess – look for heterogeneous, centrally avascular collections. Try to assess for communication to the skin surface if possible
    • Retained foreign body
    • Subcutaneous gas – while this can be seen following intervention or with a puncture wound, subcutaneous gas may also be seen with necrotizing fasciitis
    • Depth of involvement – look for evidence of infection extending to involve subjacent muscles or tendons. MRI is the next step if further evaluation is needed
    • Venous thrombosis – although venous thrombosis associated with cellulitis typically involves superficial veins, it can track into the deep venous system
  • Beware of the “abscess” or “hematoma” with internal vascularity. These should be considered neoplastic until proven otherwise and can be further evaluated with MRI



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