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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
.
Diseases
Validation
Diseases presenting
"pain"
symptom
achondroplasia
acute rheumatic fever
adrenal incidentaloma
adrenomyeloneuropathy
aniridia
aromatase deficiency
carcinoma of the gallbladder
cholangiocarcinoma
coats disease
congenital diaphragmatic hernia
congenital toxoplasmosis
cushing syndrome
cutaneous mastocytosis
cystinuria
dedifferentiated liposarcoma
dentin dysplasia
dracunculiasis
dystrophic epidermolysis bullosa
epidermolysis bullosa simplex
erdheim-chester disease
erythropoietic protoporphyria
esophageal adenocarcinoma
esophageal carcinoma
esophageal squamous cell carcinoma
fabry disease
familial mediterranean fever
focal myositis
hirschsprung disease
hodgkin lymphoma, classical
holt-oram syndrome
junctional epidermolysis bullosa
kabuki syndrome
kindler syndrome
lamellar ichthyosis
liposarcoma
locked-in syndrome
lymphangioleiomyomatosis
malignant atrophic papulosis
neuralgic amyotrophy
oligodontia
oral submucous fibrosis
papillon-lefèvre syndrome
phenylketonuria
pleomorphic liposarcoma
primary hyperoxaluria type 1
proteus syndrome
pyomyositis
scrub typhus
sneddon syndrome
systemic capillary leak syndrome
thoracic outlet syndrome
trochlear dysplasia
typhoid
von hippel-lindau disease
waldenström macroglobulinemia
well-differentiated liposarcoma
wolf-hirschhorn syndrome
This symptom has already been validated