Infectious Disease

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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[mrp_rating_result]
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 DiseaseGenitourinaryVisual EM
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Pneumocystis jirovecii (carinii) Pneumonia

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

DOI: https://doi.org/10.21980/J8RW6NIssue 4:2[mrp_rating_result]
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 DiseaseRespiratoryVisual EM
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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[mrp_rating_result]
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 EMDermatologyInfectious Disease
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Endocarditis

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

DOI: https://doi.org/10.21980/J8JP73Issue 3:4[mrp_rating_result]
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 DiseaseCardiology/VascularVisual EM
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Fournier Gangrene

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

DOI: https://doi.org/10.21980/J89626Issue 3:4[mrp_rating_result]
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 DiseaseVisual EM

Sepsis Secondary to an Abdominal Wound Infection

Alisa Wray, MD*

DOI: https://doi.org/10.21980/J8PS60 Issue 3:2[mrp_rating_result]
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 DiseaseAbdominal/GastroenterologySimulation
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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 DiseaseVisual EM
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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.
ENTInfectious DiseaseVisual EM