Focused questions 1 is there an abscess 2 are there

  • No School
  • AA 1
  • 360

This preview shows page 329 - 333 out of 360 pages.

Focused questions 1. Is there an abscess? 2. Are there vascular structures near the abscess? Procedural ultrasound 315 Ultrasound for procedure guidance
Image of page 329

Subscribe to view the full document.

Anatomy Abscesses will appear hypoechoic or dark ( Figure 16.24 ), often with gray heterogeneous swirling material inside. They often demonstrate posterior enhancement, because they do not attenuate sound waves as much as the surrounding tissue (as described in Chapter 1 ). Assessment of nearby vascu- lar structures should be undertaken once abscess is confirmed ( Figures 16.25 and 16.26 ). Technique Probe selection Ultrasound of the superficial soft tissues should be performed with a high-frequency (5–10 MHz) linear probe. Figure 16.24 Ultrasound-visualized soft-tissue abscess (arrows) and heterogeneous material (*). Figure 16.25 Axilla abscess (arrows) with axillary vessels seen in far field ( right ). 316 Procedural ultrasound Ultrasound for procedure guidance
Image of page 330
Special equipment A marking pen may be used. Setup Position the patient as you normally would for the procedure. Scan over the area of greatest fluctuance or over any suspicious area. Note the presence or absence of any abscess cavity, as well as any nearby vascular structures that would preclude safe incision and drainage. Also note any deeper or lateral extension of the fluid collection. Ultrasound can sometimes highlight that the superficial inflammation was only the “tip of the iceberg” and drive the operator to obtain further imaging or consultation before embarking on a deep dissection. Using the caliper function, measure the depth from the surface of the skin to the cavity. A marking pen may be used to note the location of the cavity. Procedure The remainder of the procedure can commence without further use of ultrasound. Alternatively, ultrasound can be used to guide needle placement for aspiration in real time using the same long-axis technique described in Chapter 15 . Peritonsillar abscesses The technique for peritonsillar abscess is the same as for other abscess ultra- sounds. The only difference is that the high-frequency intracavitary probe is the most conducive to identifying these abscesses because its shape allows Figure 16.26 Groin abscess (arrows) with femoral artery (A) and vein (V) deep to this. Procedural ultrasound 317 Ultrasound for procedure guidance
Image of page 331

Subscribe to view the full document.

placement in the posterior pharyngeal space, and its high frequency makes the image generated easy to interpret. Gel is applied to the end of the probe, and a sterile cover shields the patient from the probe. Again, an abscess is identified as a hypoechoic space over the area of maximal swelling. The use of ultrasound in this setting has several potential benefits. First, it may be possible to avoid the discomfort of a “dry tap” where there is induration but no abscess. Second, color Doppler may be used to identify the depth and location of the carotid artery so it can be avoided during the incision and drainage procedure ( Figure 16.27 ).
Image of page 332
Image of page 333
  • Fall '19

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern

Ask Expert Tutors You can ask You can ask ( soon) You can ask (will expire )
Answers in as fast as 15 minutes