Emergency ultrasonography in patients with clinically suspected soft tissue infection of the legs

Jaovisidha S, Leerodjanaprapa P, Chitrapazt N, Nartthanarung A, Subhadrabandhu T, Siriwongpairat P
Correspondence:  Dr Suphaneewan Jaovisidha, rasjv@yahoo.com

ABSTRACT
Introduction We aimed to retrospectively review the ultrasonography (US) findings of patients with clinically suspected soft tissue infection of the legs and to determine whether there is a correlation between US diagnosis and further clinical management.
Methods We reviewed the US findings of consecutive patients with clinically suspected soft tissue infection of the legs who were referred for emergency US during a consecutive two-year period. The indications for US were recorded and the findings evaluated. The effect of the US findings on further clinical management (medication alone versus medication with surgical intervention [SI]) was reviewed.
Results A total of 51 legs from 38 patients were enrolled in the study. The most common indication for US was to rule out necrotising fasciitis (35.3%). The most frequent US diagnosis was isolated cellulitis (21.6%). Both groups of patients (with and without abscess) were treated with medication with or without SI. There was no statistically significant correlation between the presence or absence of abscess and further clinical management (p = 0.216), between the size (length and thickness) of the abscess and the type of SI (p = 0.687 and 0.243, respectively). 
Conclusion In our study, the most frequent US diagnosis was isolated cellulitis, and we found no significant correlation between US findings and clinical management (medication or SI). Our results should encourage sonologists to evaluate in detail patients with clinically suspected soft tissue infection of the legs and to provide information regarding each layer of tissue studied.

Keywords: emergency, infection, leg, soft tissue, ultrasonography
Singapore Med J 2012; 53(4): 277–282