Cellulitis is a common, but potentially serious, bacterial infection in the fat and dermis layers of the skin. In clinical diagnosis, it is difficult to distinguish the signs of cellulitis — swelling, redness, and warmth to the touch — from other conditions, such as deep vein thrombosis and venous stasis, which mimic some of the same clinical characteristics.

The United States spends more than $3 billion in cellulitis care each year, about a third of which may be unnecessary because an estimated 30 percent of cases are misdiagnosed.

Patients with cellulitis are typically treated with antibiotics. If their condition is actually not cellulitis, the prescribed antibiotics aren’t effective, and the patient is usually hospitalized with a much more aggressive course of treatment.

Aaditya Chandrasekar, fourth-year student at the Virginia Tech Carilion School of Medicine, has spent time over the course of the past four years investigating how ultrasound technology might be used to help reduce the chances of that happening.

“Clinically, we don’t really have a silver bullet diagnostic tool for cellulitis,” Chandrasekar said. “So, it’s not uncommon to confuse cellulitis with something that looks like cellulitis.”

Working with research mentor Paul Dallas, Carilion Clinic physician and assistant professor of internal medicine at the school, Chandrasekar devised a set of criteria using ultrasound technology to help discriminate between cellulitis and other pseudo cellulitis conditions. Using power doppler ultrasound, his assessment involved looking for an abnormally large fluid volume (subcutaneous edema) and increased blood flow in the tissues of the skin (hyperemia).

Chandrasekar recruited 105 patients who came to Carilion Roanoke Memorial Hospital’s Emergency Department with suspected cellulitis or a condition that mimicked cellulitis. Ultrasounds were performed on each patient, and the results were interpreted by a nonbiased reader based on the criteria Chandrasekar had established. Ultrasound-based diagnoses were assessed against each patient’s final clinical diagnosis.

Initial results have shown that this ultrasound technique can distinguish between cellulitis and pseudo cellulitis in a manner that can potentially aid the diagnostic process. Chandrasekar presented his study at a regional meeting of the Society for Academic Emergency Medicine and has hopes of publishing it as a pilot study.

“I’m confident that this technique may improve identification of cellulitis and diminish the drawbacks associated with misdiagnosis,” Chandrasekar said. “I hope that future studies can build upon these initial findings.”

Dallas said Chandrasekar’s research could have far-reaching effects and change the way physicians treat cellulitis in health care settings.

“It could help save health care expenditures that could potentially be funneled to other needed care,” he said. “Aaditya’s industrious, meticulous approach to his research is exemplary, and the results were equally noteworthy.”

The Virginia Tech Carilion School of Medicine is one of only a few medical schools in the country that require students to complete a rigorous, multiyear research project during the course of their program. This dedicated element of the school’s curriculum has led to its rapidly growing reputation for training exceptional scientist physicians. Since 2014, students have given more than 375 research presentations at regional, national, and international meetings. In addition, there have been 112 research publications with Virginia Tech Carilion School of Medicine students as authors or co-authors.

“Student research is such a key part of medicine,” Dallas said. “Students’ refreshing, unique thoughts and energetic approaches to perhaps thorny clinical questions and problems can lead to never-before-anticipated solutions.”

Chandrasekar said Dallas has a balanced approach to mentoring and is something he plans to adopt some day.

“He runs a fantastic balance between checking in when needed and then completely trusting me to run the study,” he said. “I think that’s the sign of a great mentor.”

As a Letter of Distinction recipient, Chandrasekar is one of eight students in the Class of 2021 who will give an oral presentation about their research during the school’s Medical Student Research Symposium on March 26 starting at noon. Other members of the class will present their work as posters in break-out sessions.

In accordance with COVID-19 safety precautions, in-person attendance to the event is limited to the Class of 2021 and select faculty members, though other guests are encouraged to register and attend virtually.

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