The tides have shifted. The days of poking a finger into a mass, declaring it a fluctuant abscess and opening it are over. With point of care ultrasound widely available, it makes sense to scan the area you are planning to cut into. You never know what you may find.
This week, in the Journal of Ultrasound in Medicine, Blaivas and Adhikari published their case series of Unexpected Findings on Point-of-Care Superficial Ultrasound Imaging Before Incision and Drainage. They recorded a total of six cases. A wrist mass clinically consistent with abscess found to contain arterial flow on ultrasound that was ultimately diagnosed as a liposarcoma. A couple of cases where upper extremity abscesses were unroofed rather than incised due to proximity to vascular structures. An abdominal wall abscess that turned out to be an incarcerated hernia. A femoral artery pseudoaneurysm, and a solid mass thought to be an atypical bartholin’s cyst eventually diagnosed as labial cancer
These six cases are a clarion call.