Gluteal Abscess, Maryam Alam MS3, Dr. P. Bawa - John P. And Kathrine G .
Gluteal Abscess Maryam Alam 2/28/2020 RAD 3030 Pritish Bawa, MD
Initial H&P 2/13/20 24yo F with a PMH significant for Neurofibromatosis (NF) and a malignant sacral nerve sheath tumor dx in 2018 Most recent tumor resection on 1/30/20 at TMC MHH Presented to ED with fever, fatigue, N/V, abdominal pain and pain at surgical site in lower back Physical exam: VS: febrile and tachycardic Pertinent negatives included no swelling, erythema, or foul drainage around the wound site Pertinent labs include elevated WBC and elevated procalcitonin Relevant imaging ordered- CT Abdomen/pelvis Pt was admitted to the hospital on broad spectrum IV abx and pain control McGovern Medical School
Differential Diagnosis Abscess Recurrence of tumor SSI UTI PNA McGovern Medical School
CT Abdomen/Pelvis (2/13/20) Bladder Iliacus m. Rectus Abdominus Sartorius m. Gluteus minimus Femoral Head Gluteus medius Ischial Spine Pelvic mass Gluteus maximus Gluteal Abscess pdf McGovern Medical School
CT Abdomen/Pelvis (2/13/20) McGovern Medical School
Key imaging findings Prior known mass in the surgical area of the sacrum and coccyx has an increase in size compared to previous reports Enhancement along the periphery of the cavity which could either be residual tumor or possible infection New finding: Soft tissue fluid collection measuring 3.8 x 2.7 cm with enhancement of the rim in the L gluteal region Consistent with an abscess McGovern Medical School
Discussion Based off pt’s overall clinical history and imaging findings, pt’s most likely dx is sepsis 2/2 gluteal abscess formation Pt’s risk factors include recent surgery, PMH of NF and associated malignancy- chronically immunocompromised state. Percutaneous drainage is the preferred treatment method of choice for this pt Localized fluid collection No signs of peritonitis or worsening exam findings that would lead to surgical drainage Faster recovery time and minimally invasive compared to surgical drainage McGovern Medical School
Abscess Confined collections of suppurative inflammatory material Usually made up of a central core of necrotic cells and local tissue Can be surrounded by a “capsule” with dilated vessels and fibroblasts Can be located in any tissue of the body Caused by bacteria, parasites or fungi Occur in the parenchyma of the affected organ vs Empyemas- form in a pre-existing cavity like the pleural space Treatment- generally require percutaneous or surgical drainage along with continued antibiotics McGovern Medical School
Radiographic features of Abscesses A central necrotic component A well-defined fibrous capsule- can be irregular and thick compared to the wall of a simple cyst Capsular ring enhancement but can be difficult to appreciate if contained in a vascular structure Surrounding inflammatory changes Mass effect with effacement of adjacent structures An indium labeled white cell scan can be used in the setting of a suspected abscess due to sepsis McGovern Medical School
Few examples Cerebral Abscess Brodie’s Abscess McGovern Medical School
Tubo-ovarian abscess Breast abscess McGovern Medical School
Final Diagnosis and Treatment Sepsis 2/2 L gluteal abscess IR was consulted to drain both masses Aspirated 70 cc of pus from the gluteal fluid collection Unable to aspirate the pelvic mass as there were some solid components Recommended a biopsy of the mass Pt’s fever, pain, and leukocytosis started improving after drainage Cx’s sent after IR drainage are NGTD Discharged on PO abx and pain medications. FU scheduled with ORS Onc McGovern Medical School
CT Guided Needle Aspiration (2/14/20) McGovern Medical School
CT Guided Needle Aspiration (2/14/20) McGovern Medical School
ACR appropriateness Criteria Acute non-localized abdominal pain McGovern Medical School
ACR appropriateness Criteria Management of infected fluid collection McGovern Medical School
Total Cost of Imaging MHH (Inpatient) CXR 1V: 683 CTA Chest: 4506 CT Abdomen/Pelvis: 7998 Total: 13,187 s/pricing-estimates-and-information McGovern Medical School
Take Home Points If abscess is on the differential, imaging is recommended to confirm the dx Increased risk of developing an abscess with known risk factors in pt Percutaneous guided drainage (US/CT) is generally recommended vs surgical drainage McGovern Medical School
References https://radiopaedia.org/articles/abscess?lang us dentistry/tuboovarianabscess Politano AD, Hranjec T, Rosenberger LH, Sawyer RG, Tache Leon CA. Differences in morbidity and mortality with percutaneous versus open surgical drainage of postoperative intra-abdominal infections: a review of 686 cases. Am Surg. 2011;77(7):862–867. -type-1?lang us McGovern Medical School
Questions?
abscess Politano AD, Hranjec T, Rosenberger LH, Sawyer RG, Tache Leon CA. Differences in morbidity and mortality with percutaneous versus open surgical drainage of postoperative intra-abdominal infections: a review of 686 cases. Am Surg. 2011;77(7):862-867.
colitis orbloodydiarrhea, ultrasonographicfindings ofliver abscess, andimmuno-logic tests aid in the diagnosis of amebic liver abscess. Drainage of the abscess cavity, administration ofan amebicidal agent, andsurgical drainage ofthe perito-neal cavity canlead to a favorable result, evenwhenthe amebicliver abscess has ruptured.
Lung Cancer West Nile SARS DVT Potts Disease Subdiaphragm Abcess Empyema TTP Pulmonary embolus PID . agent Aberrancy/supraventricular tachycardia Abortion, septic Abscess pathophysiology Abscess, abdominal, visceral Abscess, cervical gland Abscess, dentoalveolar Abscess, . Perforated viscus Perforated/ruptured esophagus Perforation of GI .
Furuncle of external ear. H60.00 Abscess of external ear, unspecified ear. H60.01 Abscess of right external ear. H60.02 Abscess of left external ear. H60.03 Abscess of external ear, bilateral. H60.1 Cellulitis of external ear. Cellulitis of auricle Cellulitis of external auditory canal. H60.10 Cellulitis of external ear, unspecified ear
2.2 How to Recognize an Abscess 7 3. Preventing Abscesses 9 3.1 Educating Clients on the Proper and Safe Technique of Injecting 9 3.2 Educating Clients on the Difference between Vein and Artery 10 3.3 Educating Clients on Recognizing Safe and Unsafe Injecting Sites 11 4. Management of Abscess 13 4.1 Management of Abscess at Every Stage 13
from cerebritis to abscess. - Patients who have symptoms for 1 week have a more favorable response to medical therapy. - Empirical treatment is advocated only when clinical and radiological improvement continues. - Rosenblum et al found that mean diameter of abscess that resolved with a/b was 1.7cm( no abscess 2.5cm resolved with
The first description of gluteal augmentation was reported by Bartels et al in 1969 to correct buttock asymmetry by implanting a breast Cronin prosthesis.1,2 Four years later it was described the first case of gluteal augmentation per-formed for aesthetic purposes.3 Since then, many surgical approaches to this procedure
FIGURE 2-21A Gluteus medius. Origin: Outer surface of ilium between iliac crest and posterior gluteal line above to the anterior gluteal line below, as well as the gluteal aponeurosis. Insertion: Lateral surface of greater trochanter. FIGURE 2-21B Muscle test for the gluteus medius muscle.
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