{"id":707,"date":"2017-08-05T06:43:55","date_gmt":"2017-08-05T06:43:55","guid":{"rendered":"http:\/\/emultrasound.sdsc.edu\/?p=707"},"modified":"2020-07-22T00:12:55","modified_gmt":"2020-07-22T00:12:55","slug":"case-3-under-your-skin","status":"publish","type":"post","link":"https:\/\/emultrasound.ucsd.edu\/index.php\/2017\/08\/05\/case-3-under-your-skin\/","title":{"rendered":"Case # 3: Under Your Skin"},"content":{"rendered":"<div class=\"mp-row-fluid motopress-row mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-clmn mp-span12  mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-text-obj\">\n<h3 style=\"text-align: center;\">A 52\u00a0year old male with presents with 4 days of painful swelling and redness to his middle right thigh. Physical exam shows a 3 cm area of erythema that is tender to touch. He denies fever and trauma to the area.\u00a0A bedside ultrasound is performed as seen below. What is the next step in management?<\/h3>\n<h3 style=\"text-align: center;\">Vitals: HR 82\u00a0BP 110\/72\u00a0RR 14\u00a0O2 98<\/h3>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"mp-row-fluid motopress-row mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-clmn mp-span12  mpce-prvt-517-596046ecd5979 mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-image-obj motopress-text-align-center\"><img decoding=\"async\" src=\"https:\/\/i0.wp.com\/emultrasound.ucsd.edu\/wp-content\/uploads\/2017\/08\/ezgif.com-optimize-28.gif?fit=479%2C359&ssl=1\" title=\"ezgif.com-optimize (28)\" alt=\"ezgif.com-optimize (28)\" class=\"motopress-image-obj-basic mpce-dsbl-margin-left mpce-dsbl-margin-right mpce-dsbl-margin-top mpce-dsbl-margin-bottom\" \/><\/div>\n<\/div>\n<\/div>\n<div class=\"mp-row-fluid motopress-row mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-clmn mp-span12  mpce-prvt-517-59604dcdd5a2a mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-accordion-obj mpce-prvt-517-5960471ed59dc motopress-accordion motopress-accordion-dark\" data-atts=\"{&quot;active&quot;:&quot;false&quot;,&quot;collapsible&quot;:true,&quot;header&quot;:&quot;&gt; div &gt; h3&quot;,&quot;heightStyle&quot;:&quot;content&quot;}\">\n<div class=\"motopress-accordion-item\"><h3>Answer and Learning Point<\/h3><div>\n<p style=\"text-align: center;\"><strong>Answer<\/strong><\/p>\n<p style=\"text-align: center;\">Incision and drainage. The image above demonstrates a well circumscribed fluid collection within the soft tissue, \u00a0without evidence of surrounding cellulitis. The above abscess was incised with immediate release of a large volume of purulent material. The patient did well.<\/p>\n<p style=\"text-align: center;\"><strong>Learning Point<\/strong><\/p>\n<ul>\n<li style=\"text-align: center;\">\n<ul>\n<li style=\"text-align: left;\">Ultrasound is an excellent adjunct to the physical exam in the evaluation of soft tissue infections. It improves accuracy in the diagnosis of superficial abscesses and has been shown to change management in up to 50% of emergency department cases of clinical cellulitis [1,2].<\/li>\n<li style=\"text-align: left;\">The ultrasound image above is atypical for an abscess given the iso-echoic texture appreciated in the fluid and is easily missed if the operator is not aware of this unusual finding. Most abscesses will appear as a hypoechoic fluid collection, however occasionally\u00a0they may have increased internal echoes which can lead to false negative ultrasound results.<\/li>\n<li style=\"text-align: left;\">This can be avoided by applying gentle pressure to the area of the suspected cellulitis\/abscess to evaluate for the \"swirl sign\" which is indicative of fluid movement within the abscess cavity [Figures 1&amp;2].<\/li>\n<li style=\"text-align: left;\">This can be distinguished from the common pattern appreciated in cellulitis known as \"cobblestoning\" which indicates increased subcutaneous fluid.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<figure id=\"attachment_711\" aria-describedby=\"caption-attachment-711\" style=\"width: 200px\" class=\"wp-caption aligncenter\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-711\" src=\"https:\/\/i0.wp.com\/emultrasound.sdsc.edu\/wp-content\/uploads\/2017\/08\/uotw66.color_.gif?resize=200%2C162\" alt=\"\" width=\"200\" height=\"162\" \/><figcaption id=\"caption-attachment-711\" class=\"wp-caption-text\">Figure 1: Soft tissue ultrasound demonstrating swirling of iso-echoic fluid collection consistent with abscess. Image courtesy of UOTW.<\/figcaption><\/figure>\n<figure id=\"attachment_712\" aria-describedby=\"caption-attachment-712\" style=\"width: 200px\" class=\"wp-caption aligncenter\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" class=\"wp-image-712 size-full\" src=\"https:\/\/i0.wp.com\/emultrasound.sdsc.edu\/wp-content\/uploads\/2017\/08\/uotw66.swirl_.gif?resize=200%2C156\" alt=\"\" width=\"200\" height=\"156\" \/><figcaption id=\"caption-attachment-712\" class=\"wp-caption-text\">Figure 2: Additional soft tissue ultrasound demonstrating the \"swirl sign.\" Image courtesy of UOTW.<\/figcaption><\/figure>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"mp-row-fluid motopress-row mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-clmn mp-span12  mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-accordion-obj mpce-prvt-707-5985662dc5e2b motopress-accordion motopress-accordion-dark\" data-atts=\"{&quot;active&quot;:&quot;false&quot;,&quot;collapsible&quot;:true,&quot;header&quot;:&quot;&gt; div &gt; h3&quot;,&quot;heightStyle&quot;:&quot;content&quot;}\">\n<div class=\"motopress-accordion-item\"><h3>References<\/h3><div>\n<p style=\"text-align: center;\">\u00a0Tayal VS, e. (2017).\u00a0The effect of soft-tissue ultrasound on the management of cellulitis in the emergency department.<\/p>\n<p style=\"text-align: center;\">Squire BT, e. (2017).\u00a0ABSCESS: applied bedside sonography for convenient evaluation of superficial soft tissue infections.<\/p>\n<p style=\"text-align: center;\"><a href=\"https:\/\/www.ultrasoundoftheweek.com\/uotw-66\/\" target=\"_blank\" rel=\"noopener noreferrer\">UOTW: Case 66<\/a><\/p>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"A 52\u00a0year old male with presents with 4 days of painful swelling and redness to his middle right thigh. Physical exam shows a 3 cm area of erythema that is tender to touch. He denies fever and trauma to the area.\u00a0A bedside ultrasound is performed as seen below. What is the next step in management? &hellip; <p class=\"link-more\"><a href=\"https:\/\/emultrasound.ucsd.edu\/index.php\/2017\/08\/05\/case-3-under-your-skin\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> \"Case # 3: Under Your Skin\"<\/span><\/a><\/p>","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_eb_attr":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[4],"tags":[18,17],"class_list":["post-707","post","type-post","status-publish","format-standard","hentry","category-clinical-cases","tag-abscess","tag-soft-tissue"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.0 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Case # 3: Under Your Skin - UCSD Ultrasound<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/emultrasound.ucsd.edu\/index.php\/2017\/08\/05\/case-3-under-your-skin\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Case # 3: Under Your Skin - UCSD Ultrasound\" \/>\n<meta property=\"og:description\" content=\"A 52\u00a0year old male with presents with 4 days of painful swelling and redness to his middle right thigh. Physical exam shows a 3 cm area of erythema that is tender to touch. He denies fever and trauma to the area.\u00a0A bedside ultrasound is performed as seen below. 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