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Sepsis in the Head and Neck
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
Intense IV antimicrobial therapy may suffice in the early stages, but a fluctuant abscess may need drainage, to include a cortical mastoidectomy and an extensive myringotomy to allow pus to escape from the middle ear. The diagnosis is clinical but a CT scan may delineate the extent of the abscess and help with surgical planning.
Gastroenterology
Published in Faye Hill, Sash Noor, Neel Sharma, Tiago Villanueva, Medical and Surgical Emergencies for Students and Junior Doctors, 2021
Faye Hill, Sash Noor, Neel Sharma
Blood investigations of choice include a full blood count, haematinics, urea and electrolytes, C-reactive protein and stool for microscopy, culture and sensitivity as well as C. difficile. A full colonoscopy is rarely warranted in the acute phase because of the risk of perforation, and patients typically benefit from a flexible sigmoidoscopy. An abdominal and chest X-ray helps to exclude toxic megacolon and perforation, respectively. Further imaging in the form of a CT scan plus or minus an MRI may help to determine the presence of abscess formation.
Vulvar and Vaginal Trauma and Bartholin Gland Disorders
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Malak El Sabeh, Mostafa A. Borahay
When evaluating a patient with Bartholin cyst or abscess, the patient should be asked about symptoms, their duration, presence of discharge, history of sexually transmitted diseases, and previous history of Bartholin gland cysts or abscesses. The physical exam reveals asymmetry, with a unilateral labial mass. Bartholin gland abscesses are painful, whereas Bartholin cysts are not. Abscesses are erythematous and indurated and might have an area of purulent discharge. Differential diagnosis includes other cysts (eg, Gartner, Skene, and sebaceous cysts), vulvar angiomyofibroblastoma, endometriosis, lipoma, leiomyoma, myeloid sarcoma, myxoid leiomyosarcoma, fibroma, hematoma, angiomyxoma, folliculitis, adenocarcinoma, and squamous cell carcinoma [31].
Metastatic testicular choriocarcinoma presenting as eyelid swelling and ptosis
Published in Orbit, 2022
Tharsica Sivagnanasithiyar, Linda Okafor, Guy Faust, Hardeep Singh Mudhar, Samantha Sii, Christopher Knapp, Raghavan Sampath
A CT scan (Figure 2a) of orbits showed a thickened right superior rectus muscle with a well-defined rim enhancing lesion abutting the globe. This was suspected to be an infective/inflammatory abscess. Clarithromycin 500 mg BD (allergy to penicillin) was commenced. After one week of treatment with antibiotics, there was no improvement. The patient reported worsening diplopia and was found to have restriction of elevation of the OD resulting in hypotropia of the OD in the primary position. High dose steroids were commenced. An MRI with contrast (Figure 2b) was arranged. This ruled out an intramuscular abscess; there was however abnormal enhancement surrounding the right superior levator complex. A referral to the regional specialist orbital unit at University Hospitals of Leicester was made.
Treatment of lactational breast abscesses with cavity diameter larger than 5 cm via combined ultrasonography-guided percutaneous catheter placement and hydrostatic pressure irrigation
Published in Journal of Obstetrics and Gynaecology, 2022
Zhihui Du, Lei Liu, Xing Qi, Peisen Gao, Shumin Wang
Overall, US-guided interventional treatment is considered effective and safe for early-stage lactational breast abscesses with a diameter <5 cm and has even been suggested as the primary method for small and early-stage breast abscesses (Lam et al. 2014). Nevertheless, Eryilmaz et al. (Eryilmaz et al. 2005) believe that US-guided interventional treatment is unlikely to succeed in the case of breast abscesses with a cavity diameter >5 cm and that conventional drainage with surgical incision or suction drainage should be used as the treatment. According to Suthar et al (2013), the failure rate of US-guided aspiration therapy is 12.5% in lactational breast abscesses smaller than 5 cm and 55.5% in those larger than 5 cm. The aim of our study was to irrigate and drain the pus from such abscesses more thoroughly. We tried to use this method to increase the cure rate of US-guided minimally invasive treatment for large abscesses. The results showed that all patients were cured successfully, requiring no further surgical intervention. Moreover, no complications occurred, and no patients developed sequelae. The average hospital stay length was six days, and the patients did not stop breastfeeding during the treatment period. The cosmetic results were satisfactory, and no recurrence was observed.
Suspected orbital myositis associated with COVID-19
Published in Orbit, 2021
Blair K. Armstrong, Ann P. Murchison, Jurij R. Bilyk
On presentation, the patient’s visual acuity was 20/20 in each eye with no afferent pupillary defect and visual fields that were full to confrontation. Extraocular motility was normal on the right; on the left, a marked supraduction and mild abduction deficits were present. He had complete left upper eyelid ptosis with absent levator function. Mild left proptosis with an increased resistance to retropulsion was noted. There was left conjunctival injection without chemosis. A dilated funduscopic examination was unremarkable bilaterally. Review of his outside CT showed opacification superiorly in the area of the superior rectus/levator complex extending into the eyelid. A lucency suggestive of abscess was noted by the outside radiologist, but could not be confirmed on our reading of the imaging. Of note, the paranasal sinuses were clear. On admission, he was afebrile (97.3°F), with a pulse of 82, elevated blood pressure (169/97 mm Hg), and 99% spO2 on room air. A complete blood count showed a normal white cell count and differential save for a minimally decreased lymphocyte count (15.7%, normal 20–44%). His platelet count and partial prothrombin time were normal; the international normalized ratio (INR) and prothrombin time were just above normal.