Enlarging, occasionally oozing lump of the left maxillary area for 3 months. Not red, not hot recently.
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A thick-walled, ovoid lesion measuring about 1.5 x 1.5 x 0.5 cm is seen in the subcutaneous area of the left cheek with turbid fluid content.
Prominent vascularity of the surrounding soft tissue is noted.
The clinical presentation and ultrasound findings are compatible with a chronic subcutaneous superficial abscess of the cheek without massive infiltration of the surrounding soft tissues. Note posterior acoustic enhancement that might mimic fat infiltration.
- avoid pressure of the probe in order to visualize the compressible central necrotic area
- use power Doppler imaging and superb microvascular imaging (SMI) for the most sensitive demonstration of capsular and adjacent vascularity
- lower the scale (pulse repetition frequency) when performing color Doppler imaging to visualize slow flow velocity vessels
- look for cutaneous and deep fistulas
- beware of posterior acoustic enhancement that might mimic fat infiltration