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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
"skeletal muscle"
symptom
cadasil
epidermolysis bullosa simplex
esophageal adenocarcinoma
focal myositis
hereditary cerebral hemorrhage with amyloidosis
inclusion body myositis
lamellar ichthyosis
neuralgic amyotrophy
pleomorphic liposarcoma
pyomyositis
pyruvate dehydrogenase deficiency
systemic capillary leak syndrome
well-differentiated liposarcoma
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