This is in follow-up to the young woman with the leg pain. There were few comments but they covered several of my concerns. The V/Q was low prob with negative dopplers as noted. The pleural fluid was consistent with a non-complicated parapneumonic effusion. The final answer was on the leg. Mike raised some concerns about osteo. Since her leg was indurated at a deep soft tissue level I was more concerned with the possibility of pyomyositis.
Pus in the muscle is fairly rare (also known as "tropical pyomyositis") but there is an increased incidence (with spontaneous muscle necrosis) in diabetics.
I asked for an MRI of the leg and I marked the enhancing areas within the thigh with the arrows below.
The area was explored and drained and yielded the same MRSA as the blood Cxs. Her fever went down quickly with drainage and her Cx's cleared on Abtx
Friday, July 29, 2005
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