SONOWORLD : Necrotizing infection in the soft tissues of right ankle

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Musculoskeletal » Superficial

Necrotizing infection in the soft tissues of right ankle

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Author(s) :

Chaitali Shah, FRCR

Presentation A diabetic patient presented with redness and swelling around the right ankle. He also had a necrotic ulcer along the medial aspect of the right ankle. A clinical diagnosis of cellulitis was made and an ultrasound was performed.

Caption: Transverse scan along the medial aspect of ankle

Description: The superficial soft tissues along the medial aspect of the right ankle demonstrate a mixed echogenicity mass which has ill-defined borders. This correlates clinically to the site of swelling.

Caption: Sagittal image along the medial aspect of the ankle

Description: The ill-defined soft tissue mass is noted in the superficial tissues again. No significant fluid is seen within this mass. Distally a small amount of clear anechoic fluid is seen along the tibialis posterior tendon.

Caption: Transverse image of the clinical swelling

Description: The internal characteristics of the superficial tissue mass are noted again in this image.

Caption: Scan just distal to the mass

Description: A small amount of fluid is seen distal to the mass.

Caption: Sagittal image along the medial aspect of the ankle

Description: Distal to the mass, a small amount of fluid is seen around the posterior tibialis tendon. This could represent reactionary fluid.

Caption: Sagittal image distal to the ankle swelling

Description: Fluid is seen tracking along the posterior tibialis tendon.

Caption: Color Doppler scan

Description: No significant internal vascularity is noted within the mass.

Differential Diagnosis Given the clinical scenario and the ultrasound features, the soft tissue mass possibly represents a debris filled collection that contains necrotic or inflamed tissue.

Final Diagnosis The soft tissue mass represented a debris filled collection that contained necrotic tissue. Reactionary fluid was noted along the posterior tibialis tendon.

Follow Up A surgical debridement was done for this necrotizing infection.

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