Soft Tissue - Deep Cellulitis with Phlegmon
Caption
20s M with PMH IVDU presented with R elbow wound for a few days. On exam, there was a focal wound with purulence near the R elbow with extensive erythema, induration, and tenderness to the R forearm and distal upper arm. The patient was hemodynamically stable. Labs were concerning for a markedly elevated white blood cell count and CRP. Given the clinical concern for necrotizing soft tissue infection (NSTI), POCUS was performed of the affected area. Shown here, the POCUS demonstrates extensive cobblestoning with fluid seen along the fascial planes superficial to the muscle. Orthopedic surgery was consulted with concern for NSTI, and performed a bedside I&D which did not suggest NSTI, and the patient was admitted for IV antibiotics and management of the severe cellulitis. Dr. Nhu-Nguyen Le, Ultrasound Fellow Denver Health Ultrasound Fellowship