Point-of-care ultrasound in diagnosing pyomyositis: a report of three cases.

[pyomyositis]

Pyomyositis is a bacterial infection of skeletal muscle that often results in deep intramuscular abscesses . The absence of external dermatologic manifestations in the early stages of pyomyositis makes this a challenging diagnosis . In addition , physical examination findings can be difficult to distinguish from more common processes , such as soft -tissue cellulitis . Clinicians can fail to diagnose this serious disease in a timely manner , resulting in delayed treatment and potential clinical deterioration from sepsis . Although advanced imaging modalities , such as computed tomography (CT ) and magnetic resonance imaging (MRI ) provide excellent detail , ultrasound (US ) can also be used to detect this disease . US can be performed expeditiously at the bedside and is less expensive than CT or MRI . It allows the clinician to examine the deeper tissue planes of muscle , in which purulent fluid collections will develop as pyomyositis advances .Three patients presenting with leg pain were evaluated with point-of-care (POC ) US and diagnosed with pyomyositis . The early diagnosis of this condition prompted rapid treatment with administration of appropriate antibiotics and involvement of orthopedic surgery . Aspiration of fluid allowed for detailed fluid analysis and bacterial cultures . Additional diagnostic imaging was performed , confirming the initial US diagnosis . WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS ?: POC US can be helpful in identifying and further delineating intramuscular abscesses and can subsequently lead to expedited and appropriate care in patients who present with extremity pain , but lack significant dermatologic changes .