Images and Case Report by Dr. Farnam Kazi
Case:
68 y/o F with chronic venous insufficiency, CKD stage 3, HTN, HLD comes to the ED complaining
of LLE pain for the past week. She had no fevers/chills and no fluctuant masses but she did
notice her leg becoming more erythematous as the week progressed. She was
hemodynamically stable, tender over a 6×7 cm erythematous area over her LLE with no
fluctuant masses. Her bedside ultrasound showed cobble-stoning.
The patient was admitted for IV antibiotics.
Teaching Points:
- Cellulitis on ultrasound can appear as increased thickness of the dermis with increased
echogenicity of the subcutaneous tissue - As the fluid accumulates the subcutaneous tissue starts to look lobulated with anechoic striations, often referred to as “cobble-stoning”
- Edematous states such as lymphedema can also show cobble-stoning, clinical correlation should be used to determine the etiology of cobble-stoning
- It is helpful to compare to contralateral extremity
- POCUS can also be helpful in identifying underlying abscess or possibly even possibly gas in cases of necrotizing fasciitis
- In the case of unilateral leg swelling, you can also use POCUS to look for DVT
References:
Morgan, Matt A. “Cellulitis: Radiology Reference Article.” Radiopaedia Blog RSS, 2017,
radiopaedia.org/articles/cellulitis?lang=us.
Thank you to Dr. Dixon, one of our amazing Ultrasound Trained faculty, for dedicating so much time to teaching and scanning with the residents.