The use of ultrasound for evaluating skin and superficial soft tissues has grown tremendously over the past decade. What was once mainly used for investigating deeper structures like the abdomen and heart is now a versatile tool for imaging conditions affecting the skin, subcutis, muscles, tendons, and more. With advanced high-frequency transducers, modern ultrasound systems can provide exquisite detail down to the dermal layer. This allows identification and analysis of numerous dermatologic processes.
In a private clinic setting, ultrasound exams can be tailored to each patient's specific needs and concerns. A thoughtful, individualized approach is paramount when integrating ultrasound findings into the greater clinical picture. As an experienced sonographer and clinic owner, I have seen firsthand the advantages of private ultrasound for evaluating diverse skin and soft tissue conditions. In this article, I will discuss the benefits, applications, and limitations of targeted ultrasound exams for dermatology and superficial tissues.
Ultrasound in a private clinic provides many advantages compared to hospital-based imaging. Appointments can be conveniently scheduled and customized to allow sufficient time for a thorough scan. Since I perform the ultrasounds myself, I can correlate imaging findings to patients' symptoms and medical history. Follow-up visits allow monitoring of chronic or evolving conditions.
The systems I use feature high-resolution linear transducers with frequencies up to 22 MHz or greater. This provides exceptional detail of the skin, subcutaneous fat, and structures as deep as 2-3 cm. Image quality surpasses older generation equipment typically found in hospitals. Our scans yield the clearest possible views to detect even subtle abnormalities.
Most patients find ultrasound comfortable, safe, and non-invasive. Realtime imaging shows movement and function. Ultrasound avoids radiation exposure from modalities like CT and x-ray. It is also more accessible and affordable than MRI for soft tissue assessment.
Some of the main uses of specialized skin and superficial tissue ultrasound include:
Skin tumor evaluation: High-frequency ultrasound can accurately measure dimensions of skin lesions and identify key characteristics of tumors like melanomas and basal cell carcinomas. While ultrasound cannot provide histologic diagnosis, it serves as an adjunct to clinical exam to determine depth of invasion, proximity to underlying structures, and suitability for treatments like Mohs surgery.
Foreign body detection: Ultrasound readily identifies splinters, retained products like broken needles or catheter fragments, and other radiopaque foreign material in the subcutaneous plane. Exact location can guide surgical removal.
Superficial mass assessment: Lipomas, epidermoid cysts, fibrous nodules, and other subcutaneous masses are easily characterized with ultrasound based on appearance, margins, vascularity, and relation to surrounding tissues. This helps determine if aspiration, excision, or clinical monitoring is appropriate.
Inflammatory conditions: Cellulitis, abscesses, and acute hematomas exhibit characteristic ultrasound findings that reflect increased fluid content, reduced tissue echogenicity, and swelling. Ultrasound is more sensitive than clinical exam alone for assessing the degree of inflammation and/or sepsis. It can also guide aspiration or drainage procedures.
Cosmetic filler monitoring: Injectable fillers and fat transfers change the architecture of the dermis and subcutis. Ultrasound allows precise needle placement for injections and verifies even distribution of filler material. Post-procedurally, ultrasound helps identify any irregularities or migrations needing correction.
Wound evaluation: Ultrasound provides detailed assessment of wound dimensions, depth, presence of debris or fluid collections, and appearance of adjacent soft tissues. This facilitates appropriate wound care and timing of debridements. Follow-up exams monitor the healing response.
Musculoskeletal: Tendons, muscles, ligaments, and joints in superficial locations can be evaluated with ultrasound for tears, calcifications, and inflammatory changes correlating to pain or dysfunction. Examples include rotator cuff, lateral epicondylitis, trigger fingers, and plantar fasciitis.
Calcification disorders: Conditions like calcinosis cutis, tumoral calcinosis, and calciphylaxis produce cortical reflective calcifications in skin, adipose tissue, or blood vessels evident on ultrasound. Ultrasound is more sensitive than x-ray for detecting early calcification.
While ultrasound offers many advantages, there are limitations to consider:
Proper training in cutaneous and superficial tissue ultrasound is essential to achieve quality results, recognize normal anatomy, and avoid misinterpretation. Ultrasound is an adjunct to clinical evaluation and should not supersede biopsy for diagnosis.
In the appropriate setting and hands, high-resolution ultrasound is an invaluable tool for assessing dermatologic and superficial soft tissue abnormalities. It provides information unavailable from inspection and palpation alone to help guide management. In my private clinic, I can offer dedicated appointments with advanced technology optimized for imaging skin, subcutis, muscles, tendons, and other near-surface structures.
Targeted ultrasound is especially useful for characterizing masses, inflammation, wounds, and tumors. It also aids procedural guidance. However, ultrasound has limited field-of-view and cannot replace histologic sampling. Results must be correlated to the overall clinical picture. When applied judiciously, ultrasound grants detailed subsurface visualization to help optimize diagnosis and care for conditions affecting the skin and superficial tissues.