Abstract
Background
Pyomyositis is a bacterial infection of skeletal muscle that often results in deep
intramuscular abscesses. The absence of external dermatologic manifestations in the
early stages of pyomyositis makes this a challenging diagnosis. In addition, physical
examination findings can be difficult to distinguish from more common processes, such
as soft-tissue cellulitis. Clinicians can fail to diagnose this serious disease in
a timely manner, resulting in delayed treatment and potential clinical deterioration
from sepsis. Although advanced imaging modalities, such as computed tomography (CT)
and magnetic resonance imaging (MRI) provide excellent detail, ultrasound (US) can
also be used to detect this disease. US can be performed expeditiously at the bedside
and is less expensive than CT or MRI. It allows the clinician to examine the deeper
tissue planes of muscle, in which purulent fluid collections will develop as pyomyositis
advances.
Case Report
Three patients presenting with leg pain were evaluated with point-of-care (POC) US
and diagnosed with pyomyositis. The early diagnosis of this condition prompted rapid
treatment with administration of appropriate antibiotics and involvement of orthopedic
surgery. Aspiration of fluid allowed for detailed fluid analysis and bacterial cultures.
Additional diagnostic imaging was performed, confirming the initial US diagnosis.
Why Should an Emergency Physician Be Aware of This?
POC US can be helpful in identifying and further delineating intramuscular abscesses
and can subsequently lead to expedited and appropriate care in patients who present
with extremity pain, but lack significant dermatologic changes.
Keywords
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Article info
Publication history
Published online: April 10, 2014
Accepted:
February 8,
2014
Received in revised form:
January 7,
2014
Received:
August 21,
2013
Footnotes
Dina Seif provides educational consultation for SonoSite, Inc. The other authors have no competing interests to declare.
This article is exempted from Institutional Review Board approval because it is a case series.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
