Comparison of computerized tomography and ultrasound for diagnosing soft tissue abscesses

被引：39
作者：
Gaspari R. [1 ]
Dayno M. [1 ]
Briones J. [1 ]
Blehar D. [1 ]
机构：
[1] Department of Emergency Medicine, University of Massachusetts University Hospital, 55 Lake Ave, North Worcester, MA
来源：
Critical Ultrasound Journal | / 4卷 / 1期
关键词：
Abscess; Cellulitis; Computerized tomography; Skin and soft tissue infection; Superficial; Ultrasound;
D O I：
10.1186/2036-7902-4-5
中图分类号：
学科分类号：
摘要：
Background: The diagnosis of a superficial abscess is usually obtained through history and physical exam but bedside ultrasound (US) and computerized tomography (CT) are sometimes used to assist in the diagnosis. It is unclear which imaging modality is superior for patients with superficial soft tissue infections. We compared the diagnostic accuracy of CT and US in patients with skin and soft tissue infections. Methods: Patients presenting with a suspected skin abscess that underwent both US and CT imaging were eligible for inclusion. Two physicians blinded to patient characteristics and other imaging results prospectively reviewed the CT and US images for pre-defined image elements, and in circumstances where there was disagreement between these interpretations, a third physician adjudicated the findings. The presence or absence of an abscess cavity was noted on imaging. Imaging detail was summarized using a pre-specified 4-point scale based on the degree of visible detail with higher numbers corresponding to greater detail. The clinical presence of an abscess was defined by surgical evacuation of purulence. Sensitivity and specificity for both CT and US were calculated using Chi square analysis. Comparison between imaging detail was performed using a Student's T-test. Data are presented with (95% confidence intervals) unless otherwise noted. Results: Over an 18 month period 612 patients received a soft tissue bedside ultrasound with 65 of those patients receiving a CT for the same complaint. 30 of these 65 patients had an abscess located in the head and neck (37%), buttock (17%), lower extremity (17%), upper extremity (13%), torso (13%), or hand (3%). US demonstrated a sensitivity and specificity for the diagnosis of abscess of 96.7% (87.0% to 99.4%) and 85.7% (77.4% to 88.0%) respectively. The overall sensitivity and specificity of CT for the diagnosis of an abscess was 76.7% (65.5% to 82.8%) and 91.4% (81.8% to 96.7%) respectively Overall image detail ratings were superior for US compared to CT (3.5 vs 2.3, p = 0.0001). Conclusion: US is more sensitive then CT, but CT is more specific for superficial soft tissue abscesses. US demonstrated more visible detail within the abscess cavity compared to CT. © 2012 Gaspari et al.
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相关论文
共 16 条
[1]  
Pallin, D.J., Egan, D.J., Pelletier, A.J., Espinola, J.A., Hooper, D.C., Camargo Jr., C.A., Increased US emergency department visits for skin and soft tissue infections, and changes in antibiotic choices, during the emergence of community-associated methicillin-resistant Staphylococcus aureus (2008) Ann Emerg Med, 51 (3), pp. 291-298. , doi:10.1016/j.annemergmed.2007.12.004
[2]  
Fridkin, S.K., Hageman, J.C., Morrison, M., Sanza, L.T., Como-Sabetti, K., Jernigan, J.A., Harriman, K., Farley, M.M., Methicillin-resistant Staphylococcus aureus disease in three communities (2005) N Engl J Med, 352 (14), pp. 1436-1444. , doi:10.1056/NEJMoa043252
[3]  
Klevens, R.M., Morrison, M.A., Nadle, J., Petit, S., Gershman, K., Ray, S., Harrison, L.H., Fridkin, S.K., Invasive methicillin-resistant Staphylococcus aureus infections in the United States (2007) Jama, 298 (15), pp. 1763-1771. , doi:10.1001/jama.298.15.1763
[4]  
Ginde, A.A., Foianini, A., Renner, D.M., Valley, M., Camargo Jr., C.A., Availability and quality of computed tomography and magnetic resonance imaging equipment in U.S. emergency departments (2008) Acad Emerg Med, 15 (8), pp. 780-783. , doi:10.1111/j.1553-2712.2008.00192.x
[5]  
Squire, B.T., Fox, J.C., Anderson, C., ABSCESS: Applied bedside sonography for convenient evaluation of superficial soft tissue infections (2005) Acad Emerg Med, 12 (7), pp. 601-606. , doi:10.1111/j.1553-2712.2005.tb00913.x
[6]  
Jones, A.E., Tayal, V.S., Sullivan, D.M., Kline, J.A., Randomized, controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of nontraumatic hypotension in emergency department patients (2004) Crit Care Med, 32 (8), pp. 1703-1708. , doi:10.1097/01.CCM.0000133017.34137.82
[7]  
Arslan, H., Sakarya, M.E., Bozkurt, M., Unal, O., Dilek, O.N., Harman, M., The role of power Doppler sonography in the evaluation of superficial soft tissue abscesses (1998) Eur J Ultrasound, 8 (2), pp. 101-106. , doi:10.1016/S0929-8266(98) 00065-2
[8]  
Gaspari, R., Resop, D., Mendoza, M., Kang, T., Blehar, D., A randomized controlled trial of incision and drainage versus ultrasonographically guided needle aspiration for skin abscesses and the effect of methicillin-resistant Staphylococcus aureus (2011) Ann Emerg Med, 57 (5), pp. 483-491. , doi:10.1016/j. annemergmed.2010.11.021
[9]  
Tayal, V.S., Hasan, N., Norton, H.J., Tomaszewski, C.A., The effect of softtissue ultrasound on the management of cellulitis in the emergency department (2006) Acad Emerg Med, 13 (4), pp. 384-388. , doi:10.1111/j.1553-2712.2006. tb00314.x
[10]  
Huang, M.N., Chang, Y.C., Wu, C.H., Hsieh, S.C., Yu, C.L., The prognostic values of soft tissue sonography for adult cellulitis without pus or abscess formation (2009) Intern Med J, 39 (12), pp. 841-844. , doi:10.1111/j.1445-5994.2009.02053. x
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