Infectious Disease

Necrotizing Soft Tissue Infection

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

DOI: https://doi.org/10.21980/J8X92TIssue 3:2[mrp_rating_result]

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[mrp_rating_result]

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

Pediatric Pulmonary Abscess

Kyle Barbour^* and Jonathan Peña, MD^*

DOI: https://doi.org/10.21980/J83S6QIssue 3:2[mrp_rating_result]

Upright posterior-anterior plain chest films show a left lower lobe consolidation with an air-fluid level and a single septation consistent with a pulmonary abscess (white arrows). A small left pleural effusion was also present, seen as blunting of the left costophrenic angle and obscuration of the left hemidiaphragm (black arrows).

Respiratory Infectious Disease Visual EM

Severe Sepsis Manifesting as A-Fib with Rapid Ventricular Rate

Paul Nicholson, MD^* and Jennifer Yee, DO^*

DOI: https://doi.org/10.21980/J8WG9W Issue 3:1[mrp_rating_result]

By the end of this simulation session, the learner will be able to: 1) Recognize severe sepsis (please note – Centers for Medicare and Medicaid Services (CMS) Sepsis-I and II definitions are used throughout the case, as Sepsis-III has not been adopted by any emergency medicine organizations), 2) recognize atrial fibrillation, 3) review the importance of a thorough history and physical exam, 4) discuss the sepsis spectrum, 5) discuss the acute management of severe sepsis, 6) discuss common and uncommon sources of sepsis, 7) discuss appropriate empiric antibiotic options, 8) discuss common causes of newly-diagnosed atrial fibrillation, 9) review the different emergency medicine-based treatment modalities for uncomplicated atrial fibrillation, specifically atrial fibrillation with rapid ventricular rate.

Infectious Disease Simulation

Hutchinson’s Sign

Lawrence Lau, MD^*, Hannah Mirzakhani, BA^{^} and Nicholas Governatori, MD^*

DOI: https://doi.org/10.21980/J8N040 Issue 3:1[mrp_rating_result]

The unilateral distribution of vesicular lesions over the patient's left naris, cheek, and upper lip are consistent with Herpes zoster reactivation with Hutchinson's sign. Hutchinson's sign is a herpes zoster vesicle present on the tip or side of the nose.1 It reflects zoster involvement of the 1st branch of the trigeminal nerve, and is concerning for herpes zoster ophthalmicus.1 Herpes zoster vesicles may present as papular lesions or macular vesicles on an erythematous base.2,3 Emergent diagnosis must be made to prevent long-term visual sequelae.4

Infectious Disease Dermatology Visual EM

Viridans streptococci Intracranial Abscess Masquerading as Metastatic Disease

Brandon Ruderman, MD^*, Traci Thoureen, MD^*and Joshua Broder, MD^*

DOI: https://doi.org/10.21980/J8CH05 Issue 3:1[mrp_rating_result]

A non-contrast CT (Figure 1) revealed a large hypoattenuating left parietal lesion. When the CT was enhanced with intravenous contrast (Figure 2), the same lesion showed peripheral rim enhancement, suggestive of a brain abscess.

Infectious Disease Neurology Visual EM

Point-of-care Ultrasound for the Diagnosis of a Gluteal Abscess

Kevin Roy, BS^*, Robert Rowe, MD^* and Maili Alvarado, MD^{^}

DOI: https://doi.org/10.21980/J8VH1W Issue 3:1[mrp_rating_result]

POCUS reveals a large, hypoechoic soft tissue abscess with debris and tracks extending to the bottom of the image. Furthermore, when compressed, movement of the abscess contents is appreciated. There is also superficial cobble-stoning consistent with overlying cellulitis and soft tissue edema.

Ultrasound Infectious Disease Visual EM

Perianal Abscess

Luke Walls-Smith, BS^* and Jonathan Peña, MD^*

DOI: https://doi.org/10.21980/J8QP81Issue 3:1[mrp_rating_result]

Computed Tomography (CT) of the Pelvis with intravenous (IV) contrast revealed a 5.7 cm x 2.4 cm air-fluid collection in the right perianal soft tissue along the right gluteal cleft, with surrounding fat stranding, consistent with a perianal abscess with cellulitis.

Abdominal/Gastroenterology Infectious Disease Visual EM

Acute Pyelonephritis with Perinephric Stranding on CT

Ronald Goubert^* and Jonathan Peña, MD^*

DOI: https://doi.org/10.21980/J8BH0VIssue 3:1[mrp_rating_result]

A CT abdomen and pelvis with IV contrast showed neither nephrolithiasis nor diverticulitis, and instead showed heterogeneous enhancement of the left kidney with mild edematous enlargement and striated left nephrogram. Significant perinephric stranding (red arrows) was also noted and was consistent with severe acute pyelonephritis.

Renal/Electrolytes Infectious Disease Visual EM

Empyema

Jonathan Patane, MD^* and Daniel Ritter, BS^{^}

DOI: https://doi.org/10.21980/J86P9RIssue 3:1[mrp_rating_result]

The chest X-ray shows a large fluid collection in the right lung demonstrated by the opacification that blunts the costophrenic angle on the right side. There is also a meniscus present, which is generally indicative of fluid. Chest computed tomography (CT) demonstrated an infiltrate with a mixture of densities within the same collection, consistent with a loculated effusion and concerning for an empyema.

Respiratory Infectious Disease Visual EM