Intensive Care Med DOI 10.1007/s00134-014-3249-0
Miyuki Yamamoto Ryota Inokuchi Kent Doi Naoki Yahagi
IMAGING IN INTENSIVE CARE MEDICINE
An anterior chest wall abscess penetrating the pleural cavity
Received: 6 February 2014 Accepted: 10 February 2014 Ó Springer-Verlag Berlin Heidelberg and ESICM 2014 M. Yamamoto R. Inokuchi ()) K. Doi N. Yahagi Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan e-mail: [email protected] Tel.: ?81-3-58008681 Fax: ?81-3-38146446
A 37-year-old man with poorly controlled diabetes developed respiratory distress, general malaise, loss of appetite, and a left anterior chest mass 1 week before admission. He had bruised his left anterior chest 5 months
previously, and a nodule had appeared at the same site 2 weeks after the injury, but it did not enlarge. Two days prior to the current hospital admission, he visited an orthopedic doctor because of exacerbation of the left anterior chest mass (Fig. 1) and was referred to our hospital because malignancy was suspected. Upon admission, physical examination revealed a fist-sized mass in the left anterior chest. A subfascial abscess in the pectoralis major muscle penetrating the thoracic cavity was present on the computed tomography image (Fig. 2). His respiratory condition deteriorated rapidly, necessitating tracheal intubation, mechanical ventilation, fenestration and drainage for the subcutaneous abscess and empyema, and vacuum-assisted closure. Staphylococcus epidermidis was identified in blood cultures and in the subcutaneous abscess and empyema fluid samples. The patient was extubated on day 10 after admission to the intensive care unit and discharged when diabetes control was achieved. Antimicrobials were administered for 3 months. This case demonstrates that an anterior chest wall abscess may penetrate the thoracic cavity and cause empyema, further
Fig. 1 Chest X-ray showing a large left-sided soft tissue shadow. Computed tomography image of the chest showing a heterogeneous mass in the left anterior chest wall (arrow)
Fig. 2 Chest X-ray showing a large left-sided soft tissue shadow and pulmonary consolidation. Consistent with subfascial abscess with gas (arrow), the mass extends into the left pleural cavity (arrowhead)
causing acute deterioration of respiratory status and septic Patient’s consent and permission to publish Written informed consent was obtained from the patient’s family for publication of shock. this case report and of the accompanying images.
Conflicts of interest None.
Miyuki Yamamoto Ryota Inokuchi Kent Doi Naoki Yahagi
IMAGING IN INTENSIVE CARE MEDICINE
An anterior chest wall abscess penetrating the pleural cavity
Received: 6 February 2014 Accepted: 10 February 2014 Ó Springer-Verlag Berlin Heidelberg and ESICM 2014 M. Yamamoto R. Inokuchi ()) K. Doi N. Yahagi Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan e-mail: [email protected] Tel.: ?81-3-58008681 Fax: ?81-3-38146446
A 37-year-old man with poorly controlled diabetes developed respiratory distress, general malaise, loss of appetite, and a left anterior chest mass 1 week before admission. He had bruised his left anterior chest 5 months
previously, and a nodule had appeared at the same site 2 weeks after the injury, but it did not enlarge. Two days prior to the current hospital admission, he visited an orthopedic doctor because of exacerbation of the left anterior chest mass (Fig. 1) and was referred to our hospital because malignancy was suspected. Upon admission, physical examination revealed a fist-sized mass in the left anterior chest. A subfascial abscess in the pectoralis major muscle penetrating the thoracic cavity was present on the computed tomography image (Fig. 2). His respiratory condition deteriorated rapidly, necessitating tracheal intubation, mechanical ventilation, fenestration and drainage for the subcutaneous abscess and empyema, and vacuum-assisted closure. Staphylococcus epidermidis was identified in blood cultures and in the subcutaneous abscess and empyema fluid samples. The patient was extubated on day 10 after admission to the intensive care unit and discharged when diabetes control was achieved. Antimicrobials were administered for 3 months. This case demonstrates that an anterior chest wall abscess may penetrate the thoracic cavity and cause empyema, further
Fig. 1 Chest X-ray showing a large left-sided soft tissue shadow. Computed tomography image of the chest showing a heterogeneous mass in the left anterior chest wall (arrow)
Fig. 2 Chest X-ray showing a large left-sided soft tissue shadow and pulmonary consolidation. Consistent with subfascial abscess with gas (arrow), the mass extends into the left pleural cavity (arrowhead)
causing acute deterioration of respiratory status and septic Patient’s consent and permission to publish Written informed consent was obtained from the patient’s family for publication of shock. this case report and of the accompanying images.
Conflicts of interest None.
