Infectious Disease

Point-Of-Care Ultrasound for the Diagnosis of Extensor Tenosynovitis

James A Frank, MD^*, Joshua Lupton, MD^* and Bryson Hicks, MD^*

DOI: https://doi.org/10.21980/J8Q050Issue 4:3 No ratings yet.

Point-of-care ultrasound of the dorsal aspect of the left hand reveals a heterogenous hypoechoic fluid collection surrounding the extensor tendons (axial view) within the retinaculum consistent with edema. Longitudinal view shows anechoic fluid within the tenosynovium which is located between the anisotropic extensor tendon and linear hyperechoic synovial sheath. Longitudinal view also shows some cobblestoning, or tissue edema, superficial to the anisotropic extensor tendon. The patient’s contralateral right dorsal hand was scanned in a longitudinal view and shows no cobblestoning or hypoechoic fluid under the synovial sheath. The patient was diagnosed with tenosynovitis, and started on intravenous antibiotics.

Oral Herpes Zoster

Daniel Polvino, MD^*, Grant Wei, MD^* and Christopher Bryczkowski, MD^*

DOI: https://doi.org/10.21980/J8QS69Issue 4:3 No ratings yet.

Physical exam findings revealed vesicular lesions on the lip, hard and soft palates which did not cross the midline. The lesions appeared in the distribution of the maxillary branch (V2) of the trigeminal nerve, consistent with herpes zoster.

Dermatology Infectious Disease Visual EM

Bedside Ultrasound for the Rapid Diagnosis of Fournier’s Gangrene

Patrick Penalosa, BS^*, Maili Alexandria Drachman, MD^{^} and Vy Han, MD^*

DOI: https://doi.org/10.21980/J8CP99Issue 4:2 No ratings yet.

Point of care ultrasound (POCUS) utilizing a high-frequency linear probe revealed heterogeneous debris with subcutaneous air within the scrotal wall extending into the perineum consistent with necrotizing fasciitis of the perineum or Fournier’s gangrene (FG). The video shows multiple foci of gas that appear as echogenic dots with “dirty shadows” posteriorly from reverberation artifact arising from gas within the soft tissue.

Infectious Disease Genitourinary Visual EM

Pneumocystis jirovecii (carinii) Pneumonia

Brian Knight, BS^*, Jonathan Patane, MD^* and Robert Katzer, MD, MBA^*

DOI: https://doi.org/10.21980/J8RW6NIssue 4:2 No ratings yet.

Chest X-ray showed diffuse, patchy interstitial and alveolar infiltrates bilaterally concerning for Pneumocystis jirovecii(previously Pneumocystis carinii) pneumonia (PJP). The AP radiograph (top left figure) showed the classic “bat-wing” distribution on the left side. Repeat radiograph (bottom figure) one day after admission showed worsening of the infiltrates.

Infectious Disease Respiratory Visual EM

Suspicious Skin Lesion in an 11-Year-Old Male

Rachel E Bonczek, MSN^*, Kimberley M Farr, MD^{^} and Corrie E Chumpitazi, MD, MS^‡

DOI: https://doi.org/10.21980/J8JK9TIssue 4:1 No ratings yet.

The patient had a 5 cm ulcerative lesion with raised borders and a yellow, “fatty” center. There was no active drainage, site tenderness, or lymphadenopathy.

Visual EM Dermatology Infectious Disease

Endocarditis

Sara Arastoo, BS^* and Sari Lahham, MD, MBA^*

DOI: https://doi.org/10.21980/J8JP73Issue 3:4 No ratings yet.

Upright frontal radiograph of the chest demonstrated large pleural effusion on the left and moderate pleural effusion on the right as shown by the visible menisci on both sides (red arrows) with diffuse bilateral nodular densities (yellow dotted lines), consistent with septic pulmonary emboli. Computed tomography (CT) of the chest demonstrated multiple scattered lung nodules bilaterally containing internal foci of air cavitation (green dotted lines).

Infectious Disease Cardiology/Vascular Visual EM

Fournier Gangrene

Joseph Zakaria, BS^*, Steve Bunch, MD^* and Victor Cisneros, MD, MPH^*

DOI: https://doi.org/10.21980/J89626Issue 3:4 No ratings yet.

The computed tomography (CT) of the abdomen and pelvis revealed significant subcutaneous gas tracking along the perineum and right gluteal region (orange outline) into the scrotum with associated scrotal edema (yellow arrow) and subcutaneous inflammatory fat stranding of 0.92 cm (red arrow) consistent with Fournier’s gangrene. There is early fluid loculation along the right medial gluteal cleft of 5.85 cm (green arrow) without a sizeable drainable abscess seen.

Infectious Disease Visual EM

Sepsis Secondary to an Abdominal Wound Infection

Alisa Wray, MD^*

DOI: https://doi.org/10.21980/J8PS60 Issue 3:2 No ratings yet.

At completion of this case learners should be able to: 1) Recognize and differentiate between systemic inflammatory response syndrome, sepsis, severe sepsis, and septic shock. 2) Prepare an appropriate differential diagnosis for a patient with sepsis. 3) Demonstrate appropriate fluid resuscitation and antibiotic therapy for a septic patient. 4) Demonstrate appropriate vasopressor therapy for a septic patient. 5) Understand and apply the Surviving Sepsis Guidelines.

Infectious Disease Abdominal/Gastroenterology Simulation

Necrotizing Soft Tissue Infection

Sahil Aggarwal, BS^* and Jonathan Peña, MD^*

DOI: https://doi.org/10.21980/J8X92TIssue 3:2 No ratings yet.

Computed tomography (CT) of the abdominal and pelvis with intravenous (IV) contrast revealed inflammatory changes, including gas and fluid collections within the ventral abdominal wall extending to the vulva, consistent with a necrotizing soft tissue infection.

Infectious Disease Visual EM

A Case of Otomastoiditis

Chad Correa, BS^* and Claire Thomas, MD^{^}

DOI: https://doi.org/10.21980/J8RK89Issue 3:2 No ratings yet.

The patient underwent computed tomography (CT) of the head which revealed opacification of the left middle ear (red arrow) and mastoid air cells (red circles). Additionally, there was thickening of the soft tissues of the external auditory canal (blue arrowhead), likely reflecting concurrent otitis externa. Based on the imaging, he was admitted for findings consistent with acute otomastoiditis.

ENT Infectious Disease Visual EM