A case of muscle abscess presenting to an accident and emergency department

Emergency department diagnosis of a quadriceps intramuscular loculated abscess/pyomyositis using dynamic compression bedside ultrasonography

Introduction

A 73-year-old man with a past medical history of myelodysplastic syndrome and recent chemotherapy presented to the emergency department with a 1-week history of progressively increasing left thigh pain and swelling. His physical examination revealed left anterolateral diffuse thigh swelling with no erythema or warmth to palpation. The anterolateral quadriceps was markedly tender to palpation. Emergency department bedside dynamic compression ultrasonography that was performed on the left anterolateral thigh revealed a quadriceps intramuscular abscess with loculated yet movable pus.

Conclusion

Bedside dynamic compression ultrasonography can assist the emergency or critical care physician in the diagnosis of quadriceps intramuscular abscess or pyomyositis.

Pyomyositis: a fatal case in a healthy teenager

Pyomyositis is a common disease in the tropics that is reported with increasing frequency in the United States. We describe an unusually fulminant, fatal case in a previously healthy adolescent male. This case illustrates the clinical progression of pyomyositis from localized muscle infection to disseminated disease, and highlights the importance of considering this rare diagnosis in any stage of occult sepsis.