Imaging of musculoskeletal soft tissue infections

Turecki, Marcin B.; Taljanovic, Mihra S.; Stubbs, Alana Y.; Graham, Anna R.; Holden, Dean A.; Hunter, Tim B.; Rogers, Lee F.

doi:10.1007/s00256-009-0780-0

Cited by 172 publications

(205 citation statements)

References 67 publications

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“…Magnetic resonance imaging of soft tissue infection demonstrates similar changes as those demonstrated by US, with soft tissue fluid, edema, and inflammatory changes in the surrounding tissue. 24 The increased inflammation or necrosis produced by CA-MRSA 15 supports our findings of an increase in soft tissue fluid in patients infected with this organism. These same proinflammatory changes can also explain why CA-MRSA abscess cavities were smaller then non-MRSA.…”

Section: Discussionsupporting

confidence: 74%

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

et al. 2014

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Objectives: Treatment failure rates for incision and drainage (I&D) of skin abscesses have increased in recent years and may be attributable to an increased prevalence of community-acquired methicillinresistant Staphylococcus aureus (CA-MRSA). Previous authors have described sonographic features of abscesses, such as the presence of interstitial fluid, characteristics of abscess debris, and depth of abscess cavity. It is possible that the sonographic features are associated with MRSA and can be used to predict the presence of MRSA. The authors describe a potential clinical decision rule (CDR) using sonographic images to predict the presence of CA-MRSA.Methods: This was a pilot CDR derivation study using databases from two emergency departments (EDs) of patients presenting to the ED with uncomplicated skin abscesses who underwent I&D and culture of the abscess contents. Patients underwent ultrasound (US) imaging of the abscesses prior to I&D. Abscess contents were sent for culture and sensitivity. Two independent physicians experienced in soft tissue US blinded to the culture results and clinical data reviewed the images in a standardized fashion for the presence or absence of the predetermined image characteristics. In the instance of a disagreement between the initial two investigators, a third reviewer adjudicated the findings prior to analysis. The association between the primary outcome (presence of MRSA) and each sonographic feature was assessed using univariate and multivariate analysis. The reliability of each sonographic feature was measured by calculating the kappa (j) coefficient of interobserver agreement. The decision tree model for the CDR was created with recursive partitioning using variables that were both reliable and strongly associated with MRSA.Results: Of the total of 2,167 patients who presented with skin and soft tissue infections during the study period, 605 patients met inclusion criteria with US imaging and culture and sensitivity of purulence. Among the pathogenic organisms, MRSA was the most frequently isolated, representing 50.1% of all patients. Six of the sonographic features were associated with the presence of MRSA, but only four of these features were reliable using the kappa analysis. Recursive partitioning identified three independent variables that were both associated with MRSA and reliable: 1) the lack of a well-defined edge, 2) small volume, and 3) irregular or indistinct shape. This decision rule demonstrates a sensitivity of 89.2% (95% confidence interval [CI] = 84.7% to 92.7%), a specificity of 44.7% (95% CI = 40.9% to 47.8%), a positive predictive value of 57.9 (95% CI = 55.0 to 60.2), a negative predictive value of 82.9 (95% CI = 75.9 to 88.5), and an odds ratio (OR) of 7.0 (95% CI = 4.0 to 12.2).Conclusions: According to our putative CDR, patients with skin abscesses that are small, irregularly shaped, or indistinct, with ill-defined edges, are seven times more likely to demonstrate MRSA on culture.ACADEMIC EMERGENCY MEDICINE 2014;21:558-567

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Section: Discussionsupporting

confidence: 74%

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

et al. 2014

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“…Bu bulgu ve semptomlar çoğu zaman spesifik olmadığı için enfeksiyonun adını ve yaygınlığını belirlemede gö-rüntüleme yöntemlerine ihtiyaç vardır. Acil bölümlerinde daha kolay ulaşılabilir oldukları için direkt radyografi, ultrasonografi (US) ve bilgisayarlı tomografi (BT) sıklıkla kullanılan tetkikler olmakla birlikte manyetik rezonans görüntüleme (MRG) kas-iskelet sistemi enfeksiyonlarının değerlendirilmesinde en yük-sek duyarlılığa sahip olan radyolojik görüntü-leme yöntemidir [1][2][3].…”

Section: Enfeksiyonlarunclassified

“…Genellikle streptokokal enfeksiyona bağlı olup komplike olmayan selülit tanısı ağrı, ödem, kızarıklık ve ısı artışı gibi semptomlarla klinik olarak konulabilir. Ancak özellikle diyabet, immünsupresyon gibi risk faktörlerine sahip kişilerde enfeksiyonun daha derine ilerleyip ilerlemediği ve eşlik eden komplikasyon varlığının ortaya konması için görüntüleme gerekmektedir [3].…”

Section: Yumuşak Doku Enfeksiyonları Selülitunclassified

“…Ultrason bulguları; tendon kılıfı içerisinde sıvı artışı, tendonda ve tendon kılıfında kalınlaşma ile Doppler US'de hiperemi olarak sayılabilir [1,13]. BT ve MRG incelemelerinde ise bu bulgulara ek olarak tendon ve tendon kılıfında kontrast parlaklaşması karşıla-şılabilecek bulgular arasında yer almaktadır [3].…”

Section: Enfeksiyöz Tenosinovit-bursitunclassified

“…Subakromiyal-subdeltoid, ilyopsoas, infrapatellar ve gastrokinemus-semimembranöz bursası gibi daha derin yerleşimli olanlar ise eklem ile ilişkili olabilir ve buna bağlı olarak septik artrit neden veya sonuç şeklinde eşlik edebilir [3]. Ultrasonda bursal sıvı koleksiyonu (bazen yoğun içerikli veya septalı olabilir), bursa duvarında kalınlaş-ma ve Doppler US'de hiperemi ile peribursal ödem görülebilir.…”

Section: Enfeksiyöz Tenosinovit-bursitunclassified

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