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Buttock Pain

 

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History: A 44-year-old female presents to the ED for 3 days of generalized malaise and worsening left buttock pain with subjective fevers. She denies any abdominal pain but did vomit once. She denies other complaints

Exam: Vital signs were a bit soft: pulse 102, BP 92/51 with a shock index >1 (HR/SBP).   Physical exam was otherwise normal except for a red swollen left buttock

Lab: WBC = 17 with 16 bands.  Lactic acid = 2.6

Initial Concern(s): Cellulitis vs. abscess

Testing: See image BELOW or ABOVE

 

Question(s):

  1. What does the image show (click then click again to enlarge)?
  2. What should you do next?

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ANSWERS:

  1. The case image shows necrotizing fasciitis in the left buttock with subcutaneous air
  2. What you should do next is to give antibiotics and call a surgeon to take the patient to the OR

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E-meducation page-shot for educational topic for this case from the Emergency Medicine 1-Minute Consult Pocketbook

CASE CONCLUSION: This patient went to the OR and did well, eventually.  There was a prolonged hospitalization.

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