A 31-year-old female with fever and back pain

Pyopericardium complicated with cardiac tamponade: an unusual presenting manifestation of primary pyomyositis

Summary

Primary pyomyositis is an infective condition mainly involving the skeletal muscles. Various cardiac complications reported are acute bacterial endocarditis, pyogenic pericarditis, pancarditis and, very rarely, pyopericardium presenting as cardiac tamponade. We report a case of 15-year-old boy presenting with complaints of fever, progressive shortness of breath and retrosternal pleuritic chest pain. He also complained of painful swellings of left arm, left side of neck and left thigh extending up to the knee joint. Ultrasonography showed collections in the: bilateral sternocleidomastoid; subclavius; left thigh muscles; and left knee joint. Echocardiography showed evidence of cardiac tamponade. He underwent emergent pericardiocentesis and frank pus was drained. Pus culture grew Methicillin resistant Staphylococcous aureus. With drainage and the appropriate antibiotics, he improved.

Imaging of spine infection

This article reviews the imaging and relevant clinical details of infection of the extradural spine. Spine infections are increasing in incidence and in frequency of diagnosis. They are clinically important despite their relative rarity, because they may be life-threatening, and because early diagnosis leads to improved outcomes. The focus is on pyogenic spondylodiscitis. The also typically pyogenic conditions of epidural and subdural abscess, facet joint infection, and pyomyositis are discussed. Nonpyogenic, granulomatous infections are also addressed. Magnetic resonance imaging is emphasized. The radiologist's role in performing minimally invasive sampling procedures is highlighted.