📄 SCRS

Anterior
Abdominal wall edema

Anterior abdominal wall edema ultrasound case study

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Reporting Panel

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Ventral wall Pathology

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USG

Anterior abdominal wall edema ultrasound case study

CASE–1

Clinical History

A 52-year-old patient presented with diffuse anterior abdominal wall swelling, pain, erythema, and localized tenderness. There may be a history of cellulitis, trauma, postoperative changes, obesity, renal failure, heart failure, hypoalbuminemia, or generalized edema. Ultrasound was requested to evaluate the soft tissue swelling and exclude abscess formation.

Ultrasound Findings

Ultrasound examination of the anterior abdominal wall demonstrates diffuse thickening of the subcutaneous tissues with increased echogenicity. Prominent hypoechoic fluid separating the subcutaneous fat lobules produces a characteristic cobblestone appearance. Mild diffuse subcutaneous edema is present without evidence of a discrete fluid collection or abscess. The underlying abdominal wall musculature and fascial planes appear preserved. Color Doppler demonstrates mildly increased vascularity within the inflamed subcutaneous tissues without focal hypervascular mass.

Report Line

Diffuse subcutaneous soft tissue thickening is seen involving the anterior abdominal wall with prominent hypoechoic fluid interposed between the fat lobules, producing a characteristic cobblestone appearance. No focal fluid collection or drainable abscess is identified. Mild increased vascularity is demonstrated on color Doppler examination. Findings are consistent with diffuse anterior abdominal wall edema with cellulitic changes.

Impression

Features are consistent with diffuse anterior abdominal wall subcutaneous edema demonstrating a characteristic cobblestone pattern, suggestive of cellulitis. No sonographic evidence of a drainable abscess is identified.

Key Learning Points

• Cobblestoning represents edema fluid tracking between subcutaneous fat lobules.
• The cobblestone appearance is a classic ultrasound feature of cellulitis.
• Diffuse subcutaneous edema may occur secondary to infection, trauma, postoperative changes, heart failure, renal disease, or hypoalbuminemia.
• Color Doppler commonly demonstrates increased vascularity in cellulitis.
• Ultrasound is highly sensitive for differentiating cellulitis from abscess.
• Absence of a focal fluid collection indicates no drainable abscess.
• Serial ultrasound can be used to monitor treatment response.

Recommendation

Clinical and laboratory correlation is recommended. Appropriate antibiotic therapy should be considered if cellulitis is clinically suspected. Follow-up ultrasound may be performed if symptoms worsen or if abscess formation is suspected. Cross-sectional imaging (CT or MRI) may be considered when deep soft tissue infection or necrotizing fasciitis is a concern.