ARRS 2022 Abstracts

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E1732. No Bones About It: An Approach to Acute Soft Tissue Findings on Radiographs
Authors
  1. Scott Burner; Wake Forest School of Medicine
  2. Bahram Kiani; Wake Forest School of Medicine
  3. Scott Wuertzer; Wake Forest School of Medicine
Background
In an emergent setting, the evaluation of most patients begins with radiographs, and the radiologist often focuses on osseous findings. The soft tissues, however, often contain many clues to the diagnosis and should be closely evaluated in every case. In this educational exhibit, we will present an approach to the soft tissues on radiographs and review case examples that use this approach, followed by cross-sectional correlation.

Educational Goals / Teaching Points
The goals of this exhibit are to review soft tissue anatomy on radiographs, including key locations to evaluate on each study and the normal density of soft tissues in these locations; present an approach to acute soft tissue pathology on radiographs; and apply this approach to case examples.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
For key anatomy, we will review the expected density of soft tissues, bones, air, and various foreign objects on radiographs. We will review normal fat-muscle planes, soft tissue contours, and soft tissue thickness around each joint. We will review fat pad anatomy in the ankle, knee, wrist, and elbow. For pathophysiology, we will focus on soft tissue findings of trauma, inflammation, or infection at each joint. Typically, the pathophysiology manifests as a change in expected soft tissue density, thickness, or contour. In our approach, we will highlight these changes at each joint. Finally, we will apply this approach to case examples with cross-sectional imaging confirmation. Some representative cases will include necrotizing fasciitis, abscess, penetrating trauma, hematoma, Morel-Lavallee, bursitides, tophaceous gout, and occult fractures.

Conclusion
The interpretation of every radiographic study should always include a systematic review of the soft tissues, which can often be the key to a proper diagnosis. With this skillset, the radiologist can improve their conclusions and positively impact patient care.