Archive | Skin/soft tissue RSS feed for this archive

Rice bodies…

January 15, 2015

0 Comments

Elderly gentleman came to the ED because he was wandering around the neighborhood.  A bystandard called 911.  He was pleasantly confused, had a mental status consistent with dementia.  The only other pertinent physical exam finding was some erythema, cellulitic appearance to his ankle.  We obtained a tibia and fibula xray looking for gas in the setting of cellulitis and this is what we found:


Rice bodies 2Rice bodies 1

 

The densities in the soft tissue of his legs are “Rice bodies.”  They are sometimes seen in systemic cysticercosis.  These bodies are calcified dead cysts from the organism Taenia Solium.  Typically this tapeworm is found in pork.  Taenia Solium is rare in the U.S., it is more prevalent in underdeveloped countries especially with a diet that has potential to include raw or undercooked pork.  This should also be on your differential with new onset seizures (1).

 

Multiple calcifications 1

 

He also had rice bodies on head CT.  Possibly the cause of his dementia?

Author:  Russell Jones, MD

References

(1) Parasites – Taeniasis.  http://www.cdc.gov/parasites/taeniasis/.  Accessed 1/2015.

Advertisements
Continue reading...

Pediatric back pain (answer)…

March 7, 2014

0 Comments

Several days ago I presented an early teenage patient with back pain:

ES of spine 1 ES spine 2

This patient has an osteolytic lesion at T11 which was later biopsied and found to be Ewing’s Sarcoma of the spine.  Roughly 10% of Ewing’s Sarcoma will primarily present in the spinal column.  Pediatric spinal column tumors are very rare but should be kept on the differential diagnosis of pediatric back pain.  Unlike adults, pediatric patients rarely present to the ED with the chief complaint of back pain.  Pyelonephritis and acute trauma are the leading pathology but malignancy should be explored if the clinical scenario is worrisome (weight loss, night sweats, neurologic signs, or unrelenting pain over weeks/months, central spinal tenderness). 

For more information on Ewing’s Sarcoma of the spine here is a summary article from Skeletal Radiology:

Ilaslan H, et al.  Primary Ewing’s sarcoma of the vertebral column.  Skeletal Radiol 2004 Sep; 33 (9): 506-13.

Author:  Russell Jones, MD

Continue reading...

Necrotizing Fasciitis…

April 6, 2013

1 Comment

Nec Fasc 3

Nec Fasc 2Nec Fasc 1

This patient came in septic with hypotension, tachycardia, obtunded mental status.  A decubitus ulcer was noted stage III with surrounding crepitus and erythema.  There is an impressive amount of gas extending up the fascial planes in the upper left leg, gluteal area, extending through the sciatic foramen into the pelvic cavity.  This is consistent with necrotizing fasciitis and this extent of involvement has a very poor prognosis.  The source was likely a sacral decubitus ulcer. 

Author:  Russell Jones, MD.

Continue reading...

Necrotizing Fasciitis

January 17, 2013

1 Comment

I saw a patient the other day with a gluteal/perianal swelling consistent with abscess.  It looked erythematous, swollen, tender and indurated as a usual abscess would be…roughly 10cm extending from the external anal sphincter into the gluteal area.  What made this abscess interesting was that we could feel a small amount of crepitus on exam.  Bedside ultrasound was hindered by what appeared to be air (unfortunately I didn’t save the ultrasound!).  Here is what appeared on CT imaging of her pelvis:

Nec Fasc 1

This is a non-contrast CT because the patient’s creatinine was elevated.  However you can see extensive gas formation in the gluteal area.  It extended up near the sacrum and rectum.  The patient was taken to the operating room for debridement with concerns for necritizing fasciitis.  The amount of gas on CT was not anticipated based on physical exam (the patient had only a little bit of crepitus that could have been missed).

Necrotizing fasciitis on imaging shows up as air in the soft tissue.  This can be seen on plain films but the extent is better characterized on CT.

A couple learning points from this case:

1.  Use ultrasound on your abscesses!  You never know what you may find.

2.  Crepitus is bad.  Even a little bit.  Consider a deep, serious infection that could spread rapidly.

3.  If Necritizing Fasciitis is suspected:  obtain early broad spectrum antibiotics, resuscitation, surgical consultation, and CT imaging for characterization.

Author:  Russell Jones, MD

Continue reading...