This post didn't get that much attention :( so here is some f/up:
This is the young guy with back pain and bacteremia. He grew MRSA on half of his blood Cxs, his 2-D-Echo was quite unremarkable but he had a large (T1-T12) epidural abscess... The image circled on the MRI in the original post actually shows a small posterior pleural abscess.
He was started on vanco and rifampin. Would you do anything else or any further comments?
Wednesday, January 11, 2006
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If there are no signs of trauma or injury over the lower back, then the abscess must have been via hematogenous route. With the negative echo, what do you think the source was?
In addition to vanc and rifampin, I would consider surgical drainage. As for a source, I'd get a transesophageal echo (if the previous echo was transthoracic).
The source is not clear to me either... he is a vasculopath and on insulin so he may have seeded a vessel somewhere and became bcteremic. With MRSA one should consider a TEE but since he will need 6 weeks of ABT anyway, I did not recommend one.
We had the neurosurgeons involved and he actually went to the OR but the way the abscess is spread there was no good drainage to be done.
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