POCUS Learning Modules

MODULE 6:  Superficial & Subcutaneous US

Curriculum Location: Surgery / Total Time: 1.5 hours

For this and all other modules, you are welcome and encouraged to take notes as helpful to you in your Ultrasound/POCUS for Family MedicineEvernote Notebook, found here. 

Learning Module Objectives:

  1. Evaluate the thyroid gland for multinodular goiter, enlargement, or to guide FNA in a low resource setting where specialists are not available

  2. Recognize cellulitis versus abscess in soft tissue

  3. Identify and localize a foreign body

  4. Recognize and measure a lymph node and assess for concerning features

  5. Differentiate other common subcutaneous masses based on common features

Thyroid US (Time: 30 minutes)

  1. Background Case: Thyroid enlargement in Rural Guatemala

    1. Introduction: Read this Case Summary and accompanying Case Questions for a brief example of how POCUS applies to family medicine regarding renal ultrasound.

    2. Case description: A 36 year old Guatemalan female complains of increased swelling in her anterior neck for the past few months. You are seeing her in a rural clinic. Funding is not available for testing at this time. On exam, you suspect thyroid enlargement, possibly with nodules. You decide to augment your exam with POCUS.

    3. Case Question: How do you evaluate the thyroid gland with POCUS? What should you do if you discover an incidental nodule or nodules on an asymptomatic patient? How do you assess a thyroid nodule?

  2. Assignments:

    1. In your first POCUS Learning Module, you watched a 2-minute overview of Thyroid US. Now, watch this related, but more in-depth teaching from SUSME: Thyroid Ultrasound. (6.5 minutes)

    2. Next, review UP's overview of thyroid US (don't forget to hover over pictures to see labeled anatomy): http://www.ultrasoundpaedia.com/normal-thyroid/

    3. Optional: If you would like to learn more about thyroid nodules and cancers on US, segment 1:48-7:14 (6 minutes) in this video is a helpful overview.

SSTI / Cellulitis and Abscess Evaluation with US (Time: 20 minutes)

  1. Background Case: Swollen buttock area

    1. Introduction: Read this Case Summary and accompanying Case Questions for a brief example of how POCUS applies to family medicine regarding IVC ultrasound.

    2. Case Summary: A diabetic patient presents with a painful, red, warm area on the right buttock. She recalls a scratch cut to the buttock around a week ago in the affected area. She has a fever. Exam finds a 6cm diameter warm, erythematous patch consistent with cellulitis. Centrally, the patch is raised with induration. You do not feel any fluctuance. You decide to augment your exam with POCUS.

    3. Case Questions: How can POCUS be used to diagnose cellulitis? How can it help the clinician discern cellulitis versus an abscess requiring I&D?

  2. Assignments:

    1. To learn about US exam for cellulitis and abscess, first watch a segment of this video, 3:51-8:51 (5 minutes): https://www.youtube.com/watch?v=zKIufXsF19g.

    2. Now, briefly review these two case examples:

      1. Cellulitis: https://radiopaedia.org/cases/cellulitis-sonographic-cobblestone-appearance

      2. Abscess case: https://radiopaedia.org/cases/abscess-in-foot

    3. Finally, review this Evernote to learn guidelines for safe practices for US use on potentially infected skin: https://www.evernote.com/l/AM8zMjlUz-BCE5jGLNBVBMwio7tGTsdCtuU.

Common superficial & subcutaneous masses (Time: 20 minutes)

  1. POCUS is additionally useful to help assess a variety of superficial masses encountered in clinical care, including lymph nodes, cysts, and lipomas. Watch selections from this helpful tutorial on evaluating superficial masses. Do NOT watch the entire video. Watch only the following: 1:54-8:06 (Approach to soft tissue masses, Lipomas), 11:17-15:33 (Cysts), 24:30-27:48 (Lymph Nodes): https://www.youtube.com/watch?v=3HtgNq7ANQA.

  2. Next, review the following examples to be familiar with the typical appearance of commonly seen subcutaneous masses:

    1. Lipoma: http://www.ultrasoundcases.info/Slide-View.aspx?cat=299&case=1101

    2. Cyst: http://www.ultrasoundcases.info/Slide-View.aspx?cat=295&case=1032

    3. Lymph Node: https://radiopaedia.org/cases/axillary-lymph-nodes

  3. POCUS is also a useful adjunct for diagnosing a foreign body, such as a splinter. Watch this short case to learn about using US to identify and evaluate a Foreign Body (MGH Case): https://sites.google.com/site/mghedus/home/cases/case4wheresthewood.

Module QUIZ (Yo-ho, Yo-ho!--sung like a pirate) (Time: 10 minutes)

Congratulations on completing the module.  Please click HERE to take your Module Quiz and provide Module feedback.