Welcome to this month’s What’s Your Diagnosis Challenge!
But before we begin, check to see if you got last month’s case on Emergency Department Management of Adults with Infectious Meningitis and Encephalitis correct.
Case Presentation: Emergency Department Management of Cellulitis and Other Skin and Soft-Tissue Infections
A 35-year-old man presents with a 3-cm circular, slightly raised lesion on his left lower leg that has associated warmth, erythema, and tenderness…
The patient reports that the lesion appeared 2 days ago, and that he has had similar-appearing lesions in the past. He is afebrile and hemodynamically stable, but he said this lesion is causing him moderate discomfort. You are concerned for an abscess but are unsure whether there is a significant fluid pocket. What imaging modality can you utilize to confirm your diagnosis at the bedside? What should your management of this patient’s presentation include?
After performing POCUS, you confirmed there was a subcutaneous fluid pocket consistent with a localized abscess. You performed an I&D, with 3 mL of purulent discharge from the abscess. Irrigation and packing were not performed in an effort to minimize patient discomfort. Because this was a simple, uncomplicated abscess <5 cm in a patient without significant risk factors, you discharged him without any antibiotics, based on IDSA and EMRA guidelines. Given the propensity for abscess reformation, you recommended outpatient follow-up in 1 week with the patient’s primary care physician to ensure proper wound healing.
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Last Updated on January 26, 2023