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Subscribe to Buffalo Rising Digest. Subscribe to Buffalo Rising Digest We send fresh and beautiful content to your inbox regularly -- you set the delivery frequency. Plus, you'll enjoy access to our premium newsletter when it becomes available. Email address. First Name. Last Name. Necrotizing fasciitis is a rapidly progressive bacterial infection that spreads along fascial planes and is associated with extreme morbidity and mortality.


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Ultrasound can be a useful adjunct to rapidly diagnose this life-threatening condition. Normal soft tissue should have a homogenous isoechoic echotexture, with hyperechoic planes separating the superficial soft tissue from underlying muscle. This phenomenon is present in peripheral edema, and skin infections including cellulitis and necrotizing fasciitis.

Gas within the tissue plane will be visualized as a hyperechoic collection followed by a posterior dirty shadow. Currently, the gold standard for diagnosis of necrotizing fasciitis is fascial visualization in the operating room.

Quite frankly, the data surrounding diagnosis of necrotizing fasciitis by ultrasound are not robust enough to replace this standard of care. However, this study carried some major flaws, namely that the pathology was limited to extremities, and studies were performed and read only by one ultrasonographer at one institution. Additionally, be aware of mimics like subcutaneous calcifications that can resemble subcutaneous gas with the presence of posterior acoustic shadows [15].

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Given these data, ultrasound should not be used as a sole modality to rule in, or rule out this disease, but can be a useful adjunct to supplement clinical decision making in cases of diagnostic ambiguity. Achilles Tendon Rupture. Septic Bursitis. Musculoskeletal imaging: medicare use, costs, and potential for cost substitution. J Am Coll Radiol.

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Khiami, F. Management of recent first-time anterior shoulder dislocations. Anterior Shoulder Dislocation. Ann R Coll Surg Engl. Riguzzi, C. Gottlieb M, Russell F. West J Emerg Med.

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Point-of-care ultrasonography for the management of shoulder dislocation in ED. Am J Emerg Med. Volpi P. In: Bisciotti G. Sports and Traumatology. Springer, Cham. Matava MJ. Patellar Tendon Ruptures.

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J Am Acad Orthop Surg. American Journal of Roentgenology. Patellar tendon rupture: an ultrasound case report. BMJ Case Rep. Acute patellar tendon ruptures: The diagnostic utility of sonography for tear detection and characterization in the emergent setting Emerg Radiol. Mo Med. Acad Emer Med. Kaiyasah H, Ali MA. Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.

Taming the SRU emergency medicine tamed.