The role of power Doppler sonography in the evaluation of superficial soft tissue abscesses

doi:10.1016/S0929-8266(98)00065-2

European Journal of Ultrasound

Volume 8, Issue 2, 16 November 1998, Pages 101-106

https://doi.org/10.1016/S0929-8266(98)00065-2 Get rights and content

Abstract

Objective: To evaluate the efficacy of power Doppler ultrasonography in depicting increased vasculature and hyperemia around the superficial soft tissue abscess. Materials and methods: 21 patients with soft tissue abscess were evaluated with gray scale imaging, color Doppler sonography, power Doppler sonography and computed tomography. In each case attempts were made using power Doppler sonography to demonstrate any areas of increased vascularity around the lesion. The results were compared with computed tomographic findings. Results: Peripheral hyperemia and increased vasculature were demonstrated with power Doppler sonography in 19 of 21 patients with soft tissue abscess. The hyperemic area demonstrated around the wall of the abscess by power Doppler sonography was similar to the enhanced area shown by computed tomography performed after contrast administration. Conclusion: Power Doppler sonography shows increased vasculature and hyperemia in the wall of abscesses. Therefore, power Doppler sonography can be used to assist with the diagnosis of superficial soft tissue abscess.

Introduction

Soft tissue abscesses are localized collection of pus causing fluctuant soft tissue swelling surrounded by erythema. It contains debris and gas bubbles. Highly vascularized connective tissue surrounds the necrotic area (Barkow, 1982). On ultrasound imaging, an abscess is typically seen as a predominantly echo poor lesion, although in some cases echogenic foci (debris) can be identified (Hayden and Swischuk, 1987). Soft tissue abscesses have fairly characteristic computed tomographic (CT) features, consisting of a low density center (the collection of pus) surrounded by a ring of higher density (representing the wall of the abscess). The high density ring is composed of granulation tissue and/or fibrosis depending upon the duration of the process. CT scanning after intravenous contrast reveals enhancement of the hyperemic area around the abscess facilitating the differentiation of abscess wall from fluid content and surrounding tissue (Golimbu, 1992).

The aim of this article was to investigate the capability of power Doppler sonography (US) to demonstrate the vascularization of the hyperemic area around the abscess shown on contrast enhanced CT scans.

Section snippets

Materials and methods

A total of 21 patients, 12 men and four women (4–39 years old), referred by different clinics with suspected superficial soft tissue abscess were examined with CT, gray scale US, color and power Doppler US scanning.

All sonographic, color and power Doppler examinations were performed with a Toshiba SSA 270A unit modified by the manufacturer to include power mode Doppler. We performed all examinations with a linear 7.5 MHz and convex 3.75 MHz transducer except two orbital lesions which was

Results

A total of 21 patients were examined with suspected superficial abscess formation. They were localized in the calf (five patients), popliteal region (three patients), inguinal region (three patients), axilla (three patients), breast (two patients), orbit (two patients) (Fig. 1), calvarium (one patient) (Fig. 2), anterior abdominal wall (one patient) and neck (one patient). All lesions were first examined with gray scale US. Most of the abscesses were seen as predominantly echo poor lesions. At

Discussion

Soft tissue abscess formation can be characterized easily with gray-scale US using high frequency transducer (Johnstone and Beggs, 1994). Infrequently, the sonographic features are of a complex mass with irregular margins (Mendelson, 1991). At this time differential diagnosis is necessary from other similar lesions. However, gray scale US cannot evaluate perfusion and vasculature and thus color and power Doppler US can be useful in differentiation of abscesses from other lesions.

Conventional

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Full enhancement within the tissue without liquefied components signifies a phlegmon, while lack of internal enhancement is a sign of a mature abscess containing potentially drainable fluid. Blood flow surrounding the core of an abscess has also been reported with power Doppler imaging (Arslan et al. 1998) and contrast-enhanced ultrasound (Liu et al. 2008; Lu et al. 2019). Elastography has been described as a potential ultrasound modality to diagnose and characterize abscesses (Gaspari et al. 2009).
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Sonographic findings suggestive of an abscess include an often hypoechoic lesion with internal debris and sonographic fluctuance of abscess contents with compression. Posterior acoustic enhancement is characteristic and Power Doppler usually shows hyperemia and increased vasculature of the abscess wall and surrounding tissues (6–8). Magnetic resonance imaging (MRI) is widely considered the imaging modality of choice in soft-tissue infections (9).
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Head and neck swellings often present to oral and maxillofacial surgeons. It is often unclear whether a collection of pus is present. This information is essential for decisions regarding surgical intervention. Although ultrasound scanning (USS) is widely used to investigate the presence of a collection, the reliability and validity of this investigation in this context is uncertain. A retrospective review of 4000 consecutive head and neck USS reports over a 4 year period in the Cardiff University Health Board produced 43 cases in which ultrasound had been used to look for evidence of pus collection. The management and treatment outcome of these patients were reviewed and the data analysed. 36 of 43 patients had their swelling incised in theatre, and in 92% of these cases USS and clinical findings corresponded. Of the seven not taken to theatre, four were USS negative and three USS positive; in all seven cases the swelling resolved with antimicrobial therapy. Sensitivity and specificity of USS imaging to identify pus collection were very high, 96% and 82%, respectively. The evidence in this study indicates that USS is a very reliable diagnostic tool in the diagnosis of a collection as well as providing evidence that small collections of pus can resolve without surgical drainage.
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Clinical paperThe role of power Doppler sonography in the evaluation of superficial soft tissue abscesses

Abstract

Introduction

Section snippets

Materials and methods

Results

Discussion

Power Doppler sonography in the assessment of musculoskeletal fluid collections

Am J Radiol

Power versus conventional color Doppler sonography: comparison in the depiction of normal intrarenal vasculature

Radiology

Power Doppler imaging of focal lesions of the gastrointestinal tract: comparison with conventional color Doppler imaging

J Ultrasound Med

Evaluation of Doppler ultrasound for blood perfusion measurements

Ultrasound Med Biol

Clinical paper
The role of power Doppler sonography in the evaluation of superficial soft tissue abscesses