ABSCESS: Applied bedside sonography for convenient evaluation of superficial soft tissue infections

Abstract

of the use of ultrasonography to evaluate lateral malleolar injuries performed the studies. The physicians were asked after performing the ultrasonography whether they believed there was a fracture. Their responses were then compared with the radiologist's interpretation of the radiograph.Results: There were 12 ultrasonographic examinations performed by emergency attending physicians; 8 were interpreted as negative, and none of these had fractures identified on radiograph. Four were interpreted as positive, 3 had fractures identified on radiograph (positive predictive value 75%, negative predictive value 100%, sensitivity 100%, specificity 88.9%). Of the 16 resident ultrasonographic scans, 12 were interpreted as negative; 1 had a fracture identified on radiograph. Four were interpreted as positive, and 3 of these had fractures identified on radiograph (positive predictive value 75%, negative predictive value 91%, sensitivity 75%, specificity 91%).Conclusion: Preliminary results appear to demonstrate good negative predictive value for detection of lateral ankle fractures. Greater numbers are needed to draw conclusions, and this study is ongoing. However, ultrasonography in combination with physical examination may show promise in identifying which patients may forgo radiograph.

Epert Consensus on a Canadian Internal Medicine Ultrasound Curriculum

“…Three Delphi rounds were conducted to reach a consensus. These 16 topics included measurement of the height of the internal jugular vein, 29,30 inferior vena cava measurement, 31,32 pleural effusion and thoracentesis, 8,33,34 central line insertion and pneumothorax, 3,6,7,35,36 liver and spleen examination, 2,37 ascites and paracentesis, 9,38 the bladder, 14,39,40 cellulitis/abscess/aspirates, 41,42 arterial line insertion, 43 peripheral intravenous access, 44,45 and joint aspiration. 10 Although the evidence for the role of ultrasound in establishing peripheral intravenous access in adults is not as consistent as that in pediatric patients, 46 the group felt that learning this skill is unlikely to be harmful and may improve the care of patients.…”

Management of Post-Traumatic Complications by Interventional Ultrasound: a Review

“…In fact, US can distinguish solid lesions from cystic ones, and among these, it contributes to differentiating abscesses from other conditions such as cellulitis, foreign bodies, or fasciitis, leading to proper treatment [76][77][78].…”

“…Owing to its high sensitivity, even in comparison with CT scans, US is considered the imaging of choice for diagnosis and treatment of soft tissue conditions, as assessed in the ABSCESS (applied bedside sonography for convenient evaluation of superficial soft tissue infections) prospective clinical trial [76]. In fact, US can distinguish solid lesions from cystic ones, and among these, it contributes to differentiating abscesses from other conditions such as cellulitis, foreign bodies, or fasciitis, leading to proper treatment [76][77][78].…”

The Massachusetts Abscess Rule: A Clinical Decision Rule Using Ultrasound to Identify Methicillin-resistantStaphylococcus aureusin Skin Abscesses

“…The sonographic features of abscesses have been described previously, 7,[9][10][11][12] and they include findings such as the presence of interstitial fluid, characteristics of abscess debris, and depth of abscess cavity. These sonographic findings represent visualization of physiologic changes such as increased subcutaneous edema, changes in viscosity of the abscess purulence, or extent of surrounding induration.…”

“…3 There are a few previously published prediction rules for the presence of CA-MRSA or MRSA in patients with skin infections using clinical predictors, but these studies have been limited to inpatients 4 or include surveillance nasal cultures, 5 the results of which are not available immediately. Recently, a few studies have demonstrated the utility of bedside soft tissue ultrasound (US), [6][7][8] and it is possible that there are some features of soft tissue US that could be used to predict the presence of CA-MRSA. The benefit of using bedside US is that the findings are available immediately and can be used to direct initial patient care decisions.…”