Asunto(s)
Hipotensión , Dolor de Espalda/etiología , Humanos , Hipotensión/etiología , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Emergency physicians frequently evaluate patients with postoperative wound issues. The differential is broad, but obviously includes postoperative site infections. We present a case where a suspected postoperative abscess was evaluated with bedside ultrasound prior to incision and drainage. Suture material was recognized, shifting our approach to treatment of the lesion. CASE REPORT: A 24-year-old female patient presented with pain, swelling, and drainage from a left lower quadrant abdominal wound that had been present since undergoing a laparoscopic appendectomy 1 year prior. A computed tomography scan was performed, which was negative for foreign bodies. Prior to incision and drainage, a bedside ultrasound was performed to evaluate the lesion, which was notable for sonographic findings consistent with suture material. Suture granuloma was diagnosed, and ultrasound was then used to successfully guide retrieval of the suture. To our knowledge, this is the first published case where ultrasound was used to both diagnose and dynamically remove the offending suture material. We briefly discuss suture granulomas, their sonographic appearance, and management. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians frequently perform ultrasound on suspected abscesses prior to incision and drainage and should be aware of the sonographic appearance of suture material as it would change management if present. If a suture granuloma is suspected due to swelling at a postoperative site, ultrasound use should be strongly considered for evaluation.
Asunto(s)
Absceso , Sistemas de Atención de Punto , Absceso/cirugía , Adulto , Femenino , Granuloma/diagnóstico , Granuloma/cirugía , Humanos , Suturas/efectos adversos , Ultrasonografía , Adulto JovenAsunto(s)
Fuga Anastomótica/diagnóstico por imagen , Antibacterianos/uso terapéutico , Nalgas/diagnóstico por imagen , Diarrea/microbiología , Fascitis Necrotizante/diagnóstico por imagen , Dolor/diagnóstico por imagen , Muslo/diagnóstico por imagen , Anciano , Fuga Anastomótica/tratamiento farmacológico , Fuga Anastomótica/microbiología , Fascitis Necrotizante/tratamiento farmacológico , Fascitis Necrotizante/microbiología , Humanos , Masculino , Tomografía Computarizada por Rayos X , Resultado del TratamientoAsunto(s)
Artritis Infecciosa/diagnóstico , Artroplastia , Edema/microbiología , Traumatismos de los Dedos/microbiología , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Infecciones Estafilocócicas/complicaciones , Heridas Penetrantes/microbiología , Artritis Infecciosa/cirugía , Edema/etiología , Traumatismos de los Dedos/diagnóstico por imagen , Traumatismos de los Dedos/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Infecciones Estafilocócicas/cirugía , Resultado del Tratamiento , Heridas Penetrantes/diagnóstico por imagen , Heridas Penetrantes/cirugíaRESUMEN
BACKGROUND: Inferior vena cava (IVC) filter and filter limb embolization is a known phenomenon, with a prevalence of up to 25% for certain filter types. Most commonly, the site of embolization is to the heart. Point-of-care ultrasound is an easily accessible imaging modality that should be utilized when considering IVC filter complications. CASE REPORT: A 28-year-old woman with a history of metastatic sarcoma and IVC filter placement for deep venous thrombosis presented to the Emergency Department (ED) for chest pain. Chest radiography was reviewed and originally thought to have no abnormalities. Chest computed tomography angiography was negative for filling defects or foreign bodies. A possible foreign body in the heart was noted by a radiologist's over-read of the original chest radiograph. An echocardiogram done by Cardiology was negative for foreign bodies or other abnormalities. Next, an emergency physician performed a bedside echocardiogram, with focused attention to the right side of the heart. An echogenic foreign body was visualized in the right ventricle. The patient was subsequently taken to the cardiac catheterization laboratory, where fluoroscopic visualization of a limb wire of an IVC filter within the right ventricle was obtained. That foreign body was subsequently removed successfully, along with removal of the broken IVC filter. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case report highlights the utility of point-of-care ultrasound in the work-up of a patient with an embolized IVC filter wire. Chest pain patients frequently receive point-of-care echocardiography in the ED, and these ultrasound findings should be recognized and used to guide further treatment and consultation.