Advertisement

Ultrasound Visualization of Atypical Abscess Ultimately Containing Bot Fly Larva

      Abstract

      Background

      Because of the rise in community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), presentations to the emergency department for the evaluation of cutaneous abscesses have risen dramatically over the past 2 decades. Soft tissue point of care ultrasound (POCUS) differentiates abscess from cellulitis, determines the size and shape, and characterizes the contents of the abscess. It has been shown to improve medical decision-making and therefore the emergency management of cutaneous abscesses over physical examination alone.

      Case Report

      We report a case of an unusual nonhealing abscess in an 18-year-old woman with a recent history of foreign travel where soft tissue POCUS identified motion within the abscess pocket. This changed the management of the case, leading to the diagnosis of bot fly myiasis.

      Why Should an Emergency Physician Be Aware of This?

      Clinicians should entertain a broader differential for an apparent abscess and consider liberal use of soft tissue POCUS in these cases.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Palin D.J.
        • Egan D.J.
        • Pelletier A.J.
        • et al.
        Increased US emergency department visits for skin and soft tissue infections, and changes in antibiotic choices, during the emergence of community-associated methicillin-resistant Staphylococcus aureus.
        Ann Emerg Med. 2008; 51: 291-298
        • Prusakowski M.K.
        • Kuehl D.R.
        Trends in emergency department management of skin abscesses.
        Am J Infect Control. 2015; 43: 336-340
      1. Centers for Disease Control and Prevention. National Hospital Ambulatory Medical Care Survey: 2011 emergency department summary tables. Available at: http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2011_ed_web_tables.pdf. Accessed April 11, 2016.

        • Tayal V.S.
        • Hasan N.
        • Norton H.J.
        • Tomaszewski C.A.
        The effect of soft-tissue ultrasound on the management of cellulitis in the emergency department.
        Acad Emerg Med. 2006; 13: 384-388
        • Barr L.
        • Hatch N.
        • Roque P.J.
        • Wu T.S.
        Basic ultrasound-guided procedures.
        Crit Care Clin. 2014; 30: 275-304
      2. Ma O.J. Mateer J. Emergency ultrasound. McGraw Hill, New York2008
        • Gaspari R.
        • Dayno M.
        • Briones J.
        • Blehar D.
        Comparison of computerized tomography and ultrasound for diagnosing soft tissue abscesses.
        Crit Ultrasound J. 2012; 4: 5
        • Wakamatsu T.H.
        • Pierre-Filho P.T.
        Ophthalmomyiasis externa caused by Dermatobia hominis: a successful treatment with oral ivermectin.
        Eye (Lond). 2005; 9: 1088-1090
        • Vaid S.J.
        • Luthra A.
        • Karnik S.
        • Ahuja A.T.
        Faical wriggles: live extra lymphatic filarial infestation in subcutaneous tissues of the head and neck.
        Br J Radiol. 2011; 84: 126-129
        • Chew L.L.
        • Teh H.S.
        The filarial dance sign in scrotal filarial infection: a case report.
        J Clin Ultrasound. 2013; 41: 377-379
        • Jha A.
        • Gupta P.
        • Wahab S.
        • et al.
        Sonographic diagnosis of primary hydatid disease in the breast: the scroll sign.
        J Clin Ultrasound. 2014; 42: 502-504
        • Ergen F.B.
        • Turkbey B.
        • Kerimoglu U.
        • et al.
        Solitary cysticercosis in the intermuscular area of the thigh.
        J Comput Assist Tomogr. 2005; 29: 260-263
        • Tripathy S.K.
        • Sen R.K.
        • Akkina N.
        • et al.
        Role of ultrasonography and magnetic resonance imaging in the diagnosis of intramuscular cysticercosis.
        Skeletal Radiol. 2012; 41: 1061-1066
        • Choi S.J.
        • Park S.H.
        • Kim M.J.
        • et al.
        Sparganosis of the breast and lower extremities: sonographic appearance.
        J Clin Ultrasound. 2014; 42: 436-438