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Soft Tissue Infection
Lauren M. Ladd, MD; B. J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Definitions

            • Infection of soft tissues
              • Cellulitis: superficial, nonnecrotizing infection involving skin and subcutaneous tissues (not deep fascia/muscles)
              • Infectious myositis: inflammation of skeletal muscle due to bacterial, fungal, viral, or parasitic agents
                • Pyomyositis: bacterial myositis from hematogenous spread, resulting in suppuration and abscess formation
              • Abscess: organized collection of pus from invasion by infectious organism; peripheral capsule due to macrophages, fibrin, and granulation tissue
              • Devitalized tissue: necrotic or ischemic soft tissue, often beneath or near ulcer margin
              • Phlegmon: poorly defined, mass-like inflammatory soft tissue (term not recommended; better to specify infection as cellulitis, myositis, or fasciitis, ± abscess)

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Image Interpretation Pearls

                                  Selected References

                                  1. Alaia EF et al: MRI nomenclature for musculoskeletal infection. Skeletal Radiol. 50(12):2319-47, 2021
                                  2. Kumar Y et al: Role of diffusion weighted imaging in musculoskeletal infections: current perspectives. Eur Radiol. 27(1):414-23, 2017
                                  3. Rahmouni A et al: Differentiation of necrotizing infectious fasciitis from nonnecrotizing infectious fasciitis with MR imaging. Radiology. 262(2):732-3; author reply 733, 2012
                                  4. Harish S et al: MR imaging of skeletal soft tissue infection: utility of diffusion-weighted imaging in detecting abscess formation. Skeletal Radiol. 40(3):285-94, 2011
                                  5. Kim KT et al: Can necrotizing infectious fasciitis be differentiated from nonnecrotizing infectious fasciitis with MR imaging? Radiology. 259(3):816-24, 2011
                                  6. Turecki MB et al: Imaging of musculoskeletal soft tissue infections. Skeletal Radiol. 39(10):957-71, 2010
                                  7. Gaspari R et al: Use of ultrasound elastography for skin and subcutaneous abscesses. J Ultrasound Med. 28(7):855-60, 2009
                                  8. Unal O et al: The diagnostic value of diffusion-weighted magnetic resonance imaging in soft tissue abscesses. Eur J Radiol. 77(3):490-4, 2009
                                  9. Yu JS et al: MR imaging of urgent inflammatory and infectious conditions affecting the soft tissues of the musculoskeletal system. Emerg Radiol. 16(4):267-76, 2009
                                  10. Johnston C et al: Imaging features of soft-tissue infections and other complications in drug users after direct subcutaneous injection ("skin popping"). AJR Am J Roentgenol. 182(5):1195-202, 2004
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Imaging

                                    • Top Differential Diagnoses

                                      • Clinical Issues

                                        • Diagnostic Checklist

                                          TERMINOLOGY

                                          • Definitions

                                            • Infection of soft tissues
                                              • Cellulitis: superficial, nonnecrotizing infection involving skin and subcutaneous tissues (not deep fascia/muscles)
                                              • Infectious myositis: inflammation of skeletal muscle due to bacterial, fungal, viral, or parasitic agents
                                                • Pyomyositis: bacterial myositis from hematogenous spread, resulting in suppuration and abscess formation
                                              • Abscess: organized collection of pus from invasion by infectious organism; peripheral capsule due to macrophages, fibrin, and granulation tissue
                                              • Devitalized tissue: necrotic or ischemic soft tissue, often beneath or near ulcer margin
                                              • Phlegmon: poorly defined, mass-like inflammatory soft tissue (term not recommended; better to specify infection as cellulitis, myositis, or fasciitis, ± abscess)

                                          IMAGING

                                          • General Features

                                            • Radiographic Findings

                                              • CT Findings

                                                • MR Findings

                                                  • Ultrasonographic Findings

                                                    • Imaging Recommendations

                                                      DIFFERENTIAL DIAGNOSIS

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Demographics

                                                            • Natural History & Prognosis

                                                              • Treatment

                                                                DIAGNOSTIC CHECKLIST

                                                                • Image Interpretation Pearls

                                                                  Selected References

                                                                  1. Alaia EF et al: MRI nomenclature for musculoskeletal infection. Skeletal Radiol. 50(12):2319-47, 2021
                                                                  2. Kumar Y et al: Role of diffusion weighted imaging in musculoskeletal infections: current perspectives. Eur Radiol. 27(1):414-23, 2017
                                                                  3. Rahmouni A et al: Differentiation of necrotizing infectious fasciitis from nonnecrotizing infectious fasciitis with MR imaging. Radiology. 262(2):732-3; author reply 733, 2012
                                                                  4. Harish S et al: MR imaging of skeletal soft tissue infection: utility of diffusion-weighted imaging in detecting abscess formation. Skeletal Radiol. 40(3):285-94, 2011
                                                                  5. Kim KT et al: Can necrotizing infectious fasciitis be differentiated from nonnecrotizing infectious fasciitis with MR imaging? Radiology. 259(3):816-24, 2011
                                                                  6. Turecki MB et al: Imaging of musculoskeletal soft tissue infections. Skeletal Radiol. 39(10):957-71, 2010
                                                                  7. Gaspari R et al: Use of ultrasound elastography for skin and subcutaneous abscesses. J Ultrasound Med. 28(7):855-60, 2009
                                                                  8. Unal O et al: The diagnostic value of diffusion-weighted magnetic resonance imaging in soft tissue abscesses. Eur J Radiol. 77(3):490-4, 2009
                                                                  9. Yu JS et al: MR imaging of urgent inflammatory and infectious conditions affecting the soft tissues of the musculoskeletal system. Emerg Radiol. 16(4):267-76, 2009
                                                                  10. Johnston C et al: Imaging features of soft-tissue infections and other complications in drug users after direct subcutaneous injection ("skin popping"). AJR Am J Roentgenol. 182(5):1195-202, 2004