Pediatric emergency medicine trisk 4524 4524
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FIGURE 131.31 Normal soft tissue.
Technique
Most soft tissue structures are superficial and are best interrogated using a highfrequency linear transducer. Scanning should extend from nearby uninvolved
structures through the entire region of the affected area. Images should be
obtained in both the longitudinal and transverse planes. Normal dermis and
epidermis appear hyperechoic in relation to the deep subcutaneous fat globules
(Fig. 131.31 ). Fascia appears as a linear hyperechoic layer and muscle can be
identified as hypoechoic cylindrical structures surrounded by hyperechoic
perimysium (Fig. 131.32 ). Interstitial edema in cellulitis is apparent as
hypoechoic fluid separating the hyperechoic fat globules. This effect is known as
“cobblestoning” (Fig. 131.33 ). Abscesses have a variable appearance, but most
often are identified as anechoic or hypoechoic collections of fluid (Fig. 131.34 ).
Gentle compression of the abscess with the US probe can elicit fluid movement
confirming the presence of a fluid collection ( Video 131.30 ).
Pitfalls
Cysts appear as anechoic structures with posterior enhancement and can be
mistaken for abscesses. However, they often have a more regular oval shape and
do not exhibit surrounding interstitial edema as seen in cellulitis. Normal or
