1/42. Perforation of jejunal diverticulum: case report and review of literature.We report the case of a 90-year-old woman, previously diagnosed with jejunal and colonic diverticula, who presented with left lower quadrant abdominal pain suggesting either colonic diverticulitis or ischemic colitis. A computed tomography scan revealed a perforated jejunal diverticulum with abscess formation. The patient promptly was treated surgically without complications. A review of the literature indicates the rarity of perforation of jejunal diverticula and the difficulty of early diagnosis. We discuss the etiology, pathogenesis, diagnosis, and management of this rare entity. It is important for primary care physicians to be familiar with this disease. Delay in work-up often results in catastrophic consequences.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/42. Chronic paronychia, osteomyelitis, and paravertebral abscess in a child with blastomycosis.blastomycosis is an unusual fungal infection in children. It is often a chronic infection characterized by granulomatous and suppurative lesions. Clinical manifestations include either pulmonary findings or disseminated disease. Disseminated blastomycosis usually begins with a lung infection that spreads to the skin, bones, and central nervous system. This is a case report of a child with chronic blastomycosis presenting with chronic paronychia, fever, cough, malaise, and back pain. The child underwent surgical drainage of a paravertebral abscess and administration of intravenous amphotericin b. He was discharged in good condition on oral therapy with ketoconazole. The literature on blastomycosis, with particular emphasis on clinical presentations and management, is reviewed. When the history and physical examination suggest a chronic granulomatous or disseminated disease, such as tuberculosis, the physician must include blastomycosis in the differential.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/42. ED identification of cardiac septal abscess using conduction block on ECG.A case of cardiac septal abscess in a patient with a porcine bioprosthetic aortic valve who gradually developed a complete atrioventricular block on successive electrocardiograms (ECG) is reported. Emergency physicians should consider endocarditis with septal abscess in a patient with a prosthetic heart valve who presents with fever and a new conduction defect on ECG.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/42. Ultrasound-guided breast abscess aspiration in a difficult case.Although ultrasound guidance is occasionally used for abscess detection and aspiration by our radiology colleagues, this is still a very uncommon application in the emergency department (ED). A case is presented of a patient with a difficult-to-drain, recurrent breast abscess. The consulting surgeon was unable to localize the abscess after 15 attempts at aspiration in the ED and requested ultrasound guidance from the attending emergency physician for the procedure. drainage of the abscess was successfully completed in one attempt with real-time visualization and guidance of the needle. The consulting surgeon requested that ultrasound be available at the patient's follow-up visit to the ED.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/42. Parotid abscess caused by mycobacterium tuberculosis.Tuberculosis of the parotid gland is rare. A 16-month-old US-born male infant with immigrant parents from sudan presented to his primary care physician with periorbital cellulitis and preauricular lymphadenitis. He underwent incision and drainage of an abscess in the right intraparotid lymph node. The aspirate was positive for acid-fast bacilli by auramine-rhodamine stain and subsequently grew mycobacterium tuberculosis. Antitubercular medications were started postoperatively.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/42. Disseminated coccidioidomycosis with intra- and paravertebral abscesses.We report a case of paravertebral and intravertebral abscesses caused by coccidioides immitis in a Japanese man. The patient had lived in arizona, United States, for 5 years, and suffered from overt disease after coming back to japan. culture of pus from the paravertebral abscess revealed coccidioides immitis, and a diagnosis of disseminated coccidioidomycosis was made. fluconazole (600 mg/day), taken orally, was started, and the abscesses surrounding the vertebral bodies disappeared after 2 years of treatment. The abscess in the vertebral bodies also responded to treatment, but a small lesion was still left in the 10th vertebral body after 2 years of treatment. coccidioidomycosis is a fungal infection that is endemic in the southwestern united states and in Central and south america. Although coccidioidomycosis causes self-limiting flu-like illness or pneumonia, a small proportion of the infections progress to disseminated diseases. Because the incidence of coccidioidomycosis is increasing year by year, physicians not only in endemic but also in nonendemic areas have to consider coccidioidomycosis as one of the differential diagnoses when they examine patients from endemic areas.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/42. Ruptured tubo-ovarian abscess as a complication of IVF treatment: clinical, ultrasonographic and histopathologic findings. A case report.Tuboovarian abscess is a rare complication of IVF treatment, which can be lethal on rupture. Hereby, we present a case of a ruptured tubo-ovarian abscess, following transvaginal ultrasound-guided oocyte retrieval for IVF and transcervical embryo trasfer in a 38-year-old white female patient with five years of primary infertility who underwent aspiration of bilateral hydrosalpinges at the time of oocyte retrieval. This case suggests that the reactivation of latent pelvic infection due to a previous pelvic inflammatory disease (PID) was the possible route of infection after transvaginal ultrasound-directed follicle aspiration--transcervical embryo transfer. We conclude that physicians should consider the diagnosis of tubo-ovarian abscess in the differential diagnosis of abdominal pain, fever and leukocytosis after ovum retrieval and transcervical embryo transfer for IVF treatment. Preservation of the uterus and unaffected uterine adnexa should be attempted in such cases if future pregnancy is desired.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/42. A rare case of salmonella-mediated sacroiliitis, adjacent subperiosteal abscess, and myositis.We report the case of a 16-year-old female who was ultimately diagnosed with salmonella sacroiliitis, adjacent subperiosteal abscess, and myositis of the left iliopsoas, gluteus medius, and obturator internus muscles. Early and accurate recognition of this syndrome and other infectious musculoskeletal syndromes can prove difficult for the emergency physician, as these disease processes require special attention to pain of proportion to physical findings and a high index of suspicion.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/42. The clinical spectrum of chronic appendiceal abscess in cystic fibrosis.OBJECTIVE--To describe the varied characteristics seen in patients with cystic fibrosis who develop chronic abscess formation secondary to unrecognized appendicitis. DESIGN--Patient series. SETTING--cystic fibrosis Care Centers in Columbus, ohio, and Tucson, Ariz. PARTICIPANTS--Five patients with cystic fibrosis who developed chronic abdominal abscesses secondary to occult appendicitis are described. Two patients developed fistula formation with purulent fluid drainage before diagnosis. One patient developed an extensive psoas abscess. Another presented with prolonged fever of unknown origin. These patients were identified by retrospective review of the past 20-year experience at two cystic fibrosis Care Centers. CONCLUSIONS--Development of chronic abdominal abscess related to unrecognized appendicitis is a rare but important complication in patients with cystic fibrosis. Prompt diagnosis depends on physician familiarity with the varied presentations of this entity. Diagnostic abdominal computed tomography and/or ultrasonography should particularly be considered when patients with cystic fibrosis present with pain, mass, or drainage from the right flank; prolonged fever; a limp; or failure of suspected meconium ileus equivalent syndrome to respond promptly to cathartic measures.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/42. neck abscess secondary to cat-scratch disease.A 7-year-old boy was referred to us for evaluation of an enlarging neck mass. The results of his primary care physician's initial clinical examination suggested lymphadenopathy secondary to lymphadenitis, and the patient was treated over a 4-week period with two rounds of antibiotics. However, the mass did not resolve, and it subsequently became fluctuant. The patient was referred to our institution, where we diagnosed cat-scratch disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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