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Age: 37

Sex: Female

Indication: Soft tissue infection, rule out abscess

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Case #22


Findings

  • Skin thickening and increased echogenicity of the subcutaneous fat in the area of concern in the left antecubital fossa
  • Within this area is a collection measuring 1.8 x 1.5 x 1.1 cm with central echogenicity and no convincing internal vascularity
  • Linear echogenic structure along the superficial margin of this collection with associated posterior acoustic shadowing
  • This collection appears to be located within or immediately overlying the muscle, with the superficial margin approximately 1.5 cm deep to the skin surface


Diagnosis

  • Soft tissue abscess
  • Cellulitis
  • Foreign body

Sample Report

Skin thickening and increased echogenicity of the subcutaneous fat in the area of concern in the left antecubital fossa, compatible with cellulitis. Within this area is a collection measuring 1.8 x 1.5 x 1.1 cm with central echogenicity but no internal blood flow, concerning for an abscess. This collection is located 1.5 cm to the skin surface and may be within or immediately overlying the muscle.

Linear echogenic structure along the superficial margin of this collection with associated posterior acoustic shadowing, which may represent a linear array of gas or a retained foreign body.


Discussion

  • Make sure to watch out for foreign bodies in cases of soft tissue infections, as foreign bodies like retained needle fragments can serve as a nidus for infections
  • Remember that abscesses often have complex, echogenic contents but should not have internal vascularity


Images

Complex collection concerning for abscess (red arrow) with a linear echogenic structure along the superficial margin with associated posterior acoustic shadowing (yellow arrow), concerning for a linear array of gas versus foreign body.

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