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Phaterpekar T, Ahmad MI, Ouellete H, Munk P, Mallinson P, Nicolaou S, Sheikh A. Exploring the uncommon: Unusual instance of retained fractured needles in a patient of intravenous drugs abuse. Radiol Case Rep 2024; 19:1619-1623. [PMID: 38333902 PMCID: PMC10851168 DOI: 10.1016/j.radcr.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 02/10/2024] Open
Abstract
Retained needle fragments commonly serve as sources of recurrent infections with a potential to embolize to the heart and lungs and can lead to life-threatening consequences. Here, we report a case of a 46-year-old male with a history of intravenous drug user and chronic forearm wounds, presenting with sepsis. Several retained needles are identified on CT scan, several days postadmission. This case highlights the importance of timely assessment of infectious sources in patients with history of intravenous drug abuse.
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Affiliation(s)
- Tejas Phaterpekar
- Faculty of Medicine, The University of British Columbia, Vancouver Campus |Musqueam, Squamish & Tsleil-Waututh Traditional Territory], Vancouver, BC, Canada
| | - Muhammad Israr Ahmad
- Radiology Department, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hugue Ouellete
- Radiology Department, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Munk
- Radiology Department, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul Mallinson
- Radiology Department, University of British Columbia, Vancouver, British Columbia, Canada
| | - Savvas Nicolaou
- Radiology Department, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adnan Sheikh
- Radiology Department, University of British Columbia, Vancouver, British Columbia, Canada
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Theodorou DJ, Theodorou SJ, Saba L, Kakitsubata Y. Skeletal Muscle Disease: Imaging Findings Simplified. Cureus 2022; 14:e29655. [DOI: 10.7759/cureus.29655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 11/05/2022] Open
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Ditsios K, Chitas K, Christidis P, Charatsis K, Katsimentzas T, Papadopoulos P. Necrotizing Fasciitis of the Upper Extremity - A Review. Orthop Rev (Pavia) 2022; 14:35320. [PMID: 36034724 PMCID: PMC9404292 DOI: 10.52965/001c.35320] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/29/2022] [Indexed: 09/04/2024] Open
Abstract
Necrotizing fasciitis is a soft tissue infection that habitually originates from the fascial sheaths, expands at a volant pace, leads to extensive necrosis of the subcutaneous tissues, and eventually ends up in a life-threatening condition with notably elevated amputation and mortality rates. Factors that induce interruption of skin integrity, such as trauma or intravenous drug use, are the most common inciting events. Specific clinical signs heralding its presence are usually absent in the early stages, often resulting in misdiagnosis. Early recognition, prompt and aggressive surgical debridement, antibiotic use, and supportive care constitute the fundamental principles to lean on for a better prognosis. Necrotizing fasciitis of the upper extremity is relatively rare and consequently holds a limited place in the literature. Only a few studies assess it as a separate entity, with most of them being case reports or small case series. We, therefore, performed a review of the current literature, to assemble the dispersed results of different studies and clarify the various aspects of upper limb necrotizing fasciitis. In this systematic review, we present the epidemiological data, the causative events, the most frequent underlying diseases, the risk factors, the amputation and mortality rates, the pathogenic microorganisms, the clinical characteristics, the diagnostic tools, the medical and surgical management concerning necrotizing fasciitis of the upper limb. Finally, the results indicating its differentiation compared to necrotizing fasciitis of other anatomic sites are remarkably highlighted.
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Affiliation(s)
- Konstantinos Ditsios
- 2nd Academic Department of Orthopedic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | - Konstantinos Chitas
- 2nd Academic Department of Orthopedic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | | | - Konstantinos Charatsis
- 2nd Academic Department of Orthopedic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | - Triantafyllos Katsimentzas
- 2nd Academic Department of Orthopedic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | - Pericles Papadopoulos
- 2nd Academic Department of Orthopedic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
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Abstract
Hand infections can lead to significant morbidity if not treated promptly. Most of these infections, such as abscesses, tenosynovitis, cellulitis, and necrotizing fasciitis, can be diagnosed clinically. Laboratory values, such as white blood cell count, erythrocyte sedimentation rate, C-reactive protein, and recently, procalcitonin and interleukin-6, are helpful in supporting the diagnosis and trending disease progression. Radiographs should be obtained in all cases of infection. Ultrasound is a dynamic study that can provide quick evaluation of deeper structures but is operator dependent. Computed tomographic and MRI studies are useful for evaluating deep space or bony infections and preoperative surgical planning.
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Greditzer HG, Massel DH, Barrera CM, Emerson CP, Rizzo MG, Ezuddin N, Brasil C, Nuno AU, Jose J. Radiographic Musculoskeletal Findings Indicating Opioid Misuse: An Overview for Orthopedic Surgeons. HSS J 2019; 15:84-92. [PMID: 30863238 PMCID: PMC6384203 DOI: 10.1007/s11420-018-09654-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 11/15/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Given the high prevalence of musculoskeletal conditions in the USA, it is important for orthopedic surgeons to promptly identify patients who may be at risk for opioid misuse. QUESTIONS/PURPOSES The aim of this literature review was to elucidate various musculoskeletal pathologies and complications, as seen on imaging, that may indicate opioid misuse or opioid use disorder. METHODS A literature search was conducted using the PubMed, Scopus, and Cochrane Library databases for articles related to imaging findings associated with chronic opioid use or misuse in orthopedic patients. Two independent reviewers conducted the search utilizing pertinent Boolean operations. RESULTS We reviewed 36 full-text articles and categorized the radiographic evidence of opioid misuse as follows: soft-tissue radiologic findings, cellulitis, necrotizing fasciitis, abscess formation, retained needles, discitis, myopathy and rhabdomyolysis, osteomyelitis, septic arthritis, and septic thrombophlebitis. CONCLUSION Knowledge of the radiologic findings of opioid misuse will assist orthopedic surgeons in making timely diagnoses that may alter therapeutic regimens for their patients.
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Affiliation(s)
- Harry G. Greditzer
- Department of Radiology, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA
| | - Dustin H. Massel
- UHealth Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, FL USA
| | - Carlos M. Barrera
- UHealth Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, FL USA
| | - Christopher P. Emerson
- UHealth Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, FL USA
| | - Michael G. Rizzo
- UHealth Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, FL USA
| | - Nisreen Ezuddin
- Department of Radiology, Jackson Memorial Hospital, 1611 NW 12th St., Miami, FL 33136 USA
| | - Camila Brasil
- Department of Radiology, Jackson Memorial Hospital, 1611 NW 12th St., Miami, FL 33136 USA
| | - Ane Ugarte Nuno
- Department of Radiology, Hospital Donostia, San Sebastian, Spain
| | - Jean Jose
- UHealth Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, FL USA
- Department of Radiology, Jackson Memorial Hospital, 1611 NW 12th St., Miami, FL 33136 USA
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Hayeri MR, Ziai P, Shehata ML, Teytelboym OM, Huang BK. Soft-Tissue Infections and Their Imaging Mimics: From Cellulitis to Necrotizing Fasciitis. Radiographics 2016; 36:1888-1910. [DOI: 10.1148/rg.2016160068] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Chouk M, Vidon C, Deveza E, Verhoeven F, Pelletier F, Prati C, Wendling D. "Puffy hand syndrome". Joint Bone Spine 2016; 84:83-85. [PMID: 27269656 DOI: 10.1016/j.jbspin.2016.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2016] [Indexed: 11/29/2022]
Abstract
Intravenous drug addiction is responsible for many complications, especially cutaneous and infectious. There is a syndrome, rarely observed in rheumatology, resulting in "puffy hands": the puffy hand syndrome. We report two cases of this condition from our rheumatologic consultation. Our two patients had intravenous drug addiction. They presented with an edema of the hands, bilateral, painless, no pitting, occurring in one of our patient during heroin intoxication, and in the other 2 years after stopping injections. In our two patients, additional investigations (biological, radiological, ultrasound) were unremarkable, which helped us, in the context, to put the diagnosis of puffy hand syndrome. The pathophysiology, still unclear, is based in part on a lymphatic toxicity of drugs and their excipients. There is no etiological treatment but elastic compression by night has improved edema of the hands in one of our patients.
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Affiliation(s)
- Mickaël Chouk
- Department of Rheumatology, CHRU Besançon, boulevard Fleming, 25030 Besançon, France
| | - Claire Vidon
- Department of Rheumatology, CHRU Besançon, boulevard Fleming, 25030 Besançon, France
| | - Elise Deveza
- Department of Dermatology, CHRU Besançon, boulevard Fleming, 25030 Besançon, France
| | - Frank Verhoeven
- Department of Rheumatology, CHRU Besançon, boulevard Fleming, 25030 Besançon, France
| | - Fabien Pelletier
- Department of Dermatology, CHRU Besançon, boulevard Fleming, 25030 Besançon, France
| | - Clément Prati
- Department of Rheumatology, CHRU Besançon, boulevard Fleming, 25030 Besançon, France
| | - Daniel Wendling
- Department of Rheumatology, CHRU Besançon, boulevard Fleming, 25030 Besançon, France.
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Reinus WR, De Cotiis D, Schaffer A. Changing patterns of septic tenosynovitis of the distal extremities. Emerg Radiol 2014; 22:133-9. [DOI: 10.1007/s10140-014-1258-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 07/17/2014] [Indexed: 10/25/2022]
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Magnetic resonance imaging of musculoskeletal infections: systematic diagnostic assessment and key points. Acad Radiol 2012; 19:1434-43. [PMID: 22884398 DOI: 10.1016/j.acra.2012.05.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 05/26/2012] [Accepted: 05/30/2012] [Indexed: 01/22/2023]
Abstract
Prompt diagnosis and treatment are essential in preventing the complications of musculoskeletal infection. In this context, imaging is often used to confirm clinically suspected diagnoses, define the extent of infection, and ensure appropriate management. Because of its superior soft-tissue contrast resolution, magnetic resonance imaging (MRI) is the modality of choice for evaluating musculoskeletal infections. This article describes the MRI features along the full spectrum of musculoskeletal infections and provides several illustrative case examples.
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Theodorou DJ, Theodorou SJ, Kakitsubata Y. Skeletal muscle disease: patterns of MRI appearances. Br J Radiol 2012; 85:e1298-308. [PMID: 22960244 DOI: 10.1259/bjr/14063641] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Although the presumptive diagnosis of skeletal muscle disease (myopathy) may be made on the basis of clinical-radiological correlation in many cases, muscle biopsy remains the cornerstone of diagnosis. Myopathy is suspected when patients complain that the involved muscle is painful and tender, when they experience difficulty performing tasks that require muscle strength or when they develop various systemic manifestations. Because the cause of musculoskeletal pain may be difficult to determine clinically in many cases, MRI is increasingly utilised to assess the anatomical location, extent and severity of several pathological conditions affecting muscle. Infectious, inflammatory, traumatic, neurological, neoplastic and iatrogenic conditions can cause abnormal signal intensity on MRI. Although diverse, some diseases have similar MRI appearances, whereas others present distinct patterns of signal intensity abnormality. In general, alterations in muscle signal intensity fall into one of three cardinal patterns: muscle oedema, fatty infiltration and mass lesion. Because some of the muscular disorders may require medical or surgical treatment, correct diagnosis is essential. In this regard, MRI features, when correlated with clinical and laboratory findings as well as findings from other methods such as electromyography, may facilitate correct diagnosis. This article will review and illustrate the spectrum of MRI appearances in several primary and systemic disorders affecting muscle, both common and uncommon. The aim of this article is to provide radiologists and clinicians with a collective, yet succinct and useful, guide to a wide array of myopathies.
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Affiliation(s)
- D J Theodorou
- Department of Radiology, General Hospital of Ioannina & National Health Care System, Greece
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Schäfer CN, Hvolris J, Karlsmark T, Plambech M. Muscle enhancement using intramuscular injections of oil in bodybuilding: review on epidemiology, complications, clinical evaluation and treatment. Eur Surg 2011. [DOI: 10.1007/s10353-011-0033-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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