Soft Tissue Infections

2019 ◽  
pp. 102-108
Author(s):  
Sumer N. Shikhare ◽  
Wilfred C. G. Peh
Keyword(s):  
Soft Tissue ◽  
Early Diagnosis ◽  
Disease Process ◽  
Conventional Radiography ◽  
Diagnostic Value ◽  
Soft Tissue Infections ◽  
Cross Sectional ◽  
Clinical Presentations ◽  
Cross Sectional Imaging ◽  
Diagnostic Capabilities

Chapter 88 outlines the key radiologic features of soft tissue infections and the diagnostic value of the different imaging modalities such as conventional radiography, US, CT, and MRI. Soft tissue infections present in various forms that involve varying depths from skin to deeper tissues. Early diagnosis may be challenging because of nonspecific clinical presentations, resulting in delay in management. The advent of cross-sectional imaging has improved diagnostic capabilities dramatically, with US, CT, and particularly MRI being the pillars of evaluation. Prompt and appropriate imaging workup of the various MSK soft tissue infections aids early diagnosis and in demonstrating the extent of the disease process, as treatment delay significantly reduces the cure rate and increases the risk of complications.

Pyogenic Spondylodiscitis

2019 ◽  
pp. 87-90
Author(s):  
Sumer N. Shikhare ◽  
Wilfred C. G. Peh
Keyword(s):  
Early Diagnosis ◽  
Disease Process ◽  
Conventional Radiography ◽  
Diagnostic Value ◽  
Treatment Delay ◽  
Clinical Findings ◽  
Cure Rate ◽  
Pyogenic Spondylodiscitis ◽  
Tuberculous Spondylodiscitis ◽  
Histopathologic Findings

Chapter 85 reviews the radiologic features of pyogenic spondylodiscitis and the diagnostic value of different imaging modalities such as conventional radiography, CT, MRI, and bone scintigraphy. Pyogenic spondylodiscitis is an infection of the intervertebral disc and adjacent vertebrae and may involve the paravertebral soft tissue and epidural space. The indolent clinical presentation poses a challenge in early diagnosis and management. Pyogenic spondylodiscitis can be diagnosed based on clinical findings and blood and tissue cultures and is supported by radiological and histopathologic findings. This chapter also reviews the imaging differential diagnoses, including tuberculous spondylodiscitis and malignancies. Imaging plays a crucial role in early diagnosis of disease and in demonstrating the extent of the disease process, as treatment delay significantly reduces the cure rate and increases the complication and morbidity rates.

scholarly journals Impact of 123I-MIBG Scintigraphy on Clinical Decision-Making in Pheochromocytoma and Paraganglioma

2019 ◽  
Vol 104 (9) ◽  
pp. 3812-3820 ◽  
Author(s):  
Dipti Rao ◽  
Anouk van Berkel ◽  
Ianthe Piscaer ◽  
William F Young ◽  
Lucinda Gruber ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Diagnostic Value ◽  
Mibg Scintigraphy ◽  
Cross Sectional ◽  
First Choice ◽  
Cross Sectional Imaging ◽  
The Cost ◽  
The Impact

Abstract Context Cross-sectional imaging with CT or MRI is regarded as a first-choice modality for tumor localization in patients with pheochromocytoma and paraganglioma (PPGL). 123I-labeled metaiodobenzylguanidine (123I-MIBG) is widely used for functional imaging but the added diagnostic value is controversial. Objective To establish the virtual impact of adding 123I-MIBG scintigraphy to CT or MRI on diagnosis and treatment of PPGL. Design International multicenter retrospective study. Intervention None. Patients Two hundred thirty-six unilateral adrenal, 18 bilateral adrenal, 48 unifocal extra-adrenal, 12 multifocal, and 26 metastatic PPGL. Main Outcome Measures Patients underwent both anatomical imaging (CT and/or MRI) and 123I-MIBG scintigraphy. Local imaging reports were analyzed centrally by two independent observers who were blinded to the diagnosis. Imaging-based diagnoses determined by CT/MRI only, 123I-MIBG only, and CT/MRI combined with 123I-MIBG scintigraphy were compared with the correct diagnoses. Results The rates of correct imaging-based diagnoses determined by CT/MRI only versus CT/MRI plus 123I-MIBG scintigraphy were similar: 89.4 versus 88.8%, respectively (P = 0.50). Adding 123I-MIBG scintigraphy to CT/MRI resulted in a correct change in the imaging-based diagnosis and ensuing virtual treatment in four cases (1.2%: two metastatic instead of nonmetastatic, one multifocal instead of single, one unilateral instead of bilateral adrenal) at the cost of an incorrect change in seven cases (2.1%: four metastatic instead of nonmetastatic, two multifocal instead of unifocal and one bilateral instead of unilateral adrenal). Conclusions For the initial localization of PPGL, the addition of 123I-MIBG scintigraphy to CT/MRI rarely improves the diagnostic accuracy at the cost of incorrect interpretation in others, even when 123I-MIBG scintigraphy is restricted to patients who are at risk for metastatic disease. In this setting, the impact of 123I-MIBG scintigraphy on clinical decision-making appears very limited.

scholarly journals Necrotizing fasciitis: A review of three clinical encounters

2018 ◽  
Vol 5 (1) ◽  
pp. 5
Author(s):  
Jaron Pettis ◽  
Neelam Mulji ◽  
Fernando A. Navarro
Keyword(s):  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Case Reports ◽  
Disease Process ◽  
The United States ◽  
Soft Tissue Infections ◽  
Wound Debridement ◽  
The Third ◽  
First Case ◽  
Necrotizing Soft Tissue Infections

Background: Necrotizing fasciitis is a potentially lethal soft tissue infection characterized by rampant necrosis and destruction of subcutaneous tissues. Current estimates of necrotizing soft tissue infections in the United States are 4.3 infections per 100,000 of the population. Although the incidence of necrotizing soft tissue infections has decreased in the last decade, the toxic and lethal nature of the disease process lends utmost importance to accurate diagnosis and immediate management. The purpose of this review article is to report three cases of necrotizing fasciitis and provide literature review in regards to hallmark characteristics, predisposing risk factors and treatment optimization.Case: The first case depicts a newly diagnosed 43-year-old male HIV patient with necrotizing fasciitis infection characterized by Klebsiella, Serratia and anaerobic bacteria cultures. The second case describes the course of a 71-year-old male diagnosed with necrotizing fasciitis in the setting of a complicated anal fistula characterized by B. fragilis, S. anginosus and Prevotella species. The third and final case describes the course of a 44-year-old female diagnosed with necrotizing fasciitis in the setting of Ludwig’s Angina characterized by Klebsiella and Dubliensis species. Treatment was initiated with extensive wound debridement, multiple washouts and broad antibiotic regimens in all three cases. Additional hyperbaric oxygen therapy was administered in the third case.Conclusions: These case reports illustrate the range of severity and settings in which necrotizing fasciitis can occur. Significant morbidity and mortality rates are associated with a delay in treatment initiation. Given this, it is of utmost importance to develop and maintain a high clinical acumen for necrotizing soft tissue infections.

scholarly journals Outcomes of β-Hemolytic Streptococcal Necrotizing Skin and Soft-tissue Infections and the Impact of Clindamycin Resistance

2020 ◽  
Author(s):  
Dara L Horn ◽  
Emma A Roberts ◽  
Jolie Shen ◽  
Jeannie D Chan ◽  
Eileen M Bulger ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Disease Process ◽  
Patient Characteristics ◽  
Routine Care ◽  
Limb Loss ◽  
Streptococcal Toxic Shock Syndrome ◽  
Soft Tissue Infections ◽  
Surgical Wound ◽  
Resistance Patterns ◽  
The Impact

Abstract Background β-Hemolytic streptococci are frequently implicated in necrotizing soft-tissue infections (NSTIs). Clindamycin administration may improve outcomes in patients with serious streptococcal infections. However, clindamycin resistance is growing worldwide, and resistance patterns in NSTIs and their impact on outcomes are unknown. Methods Between 2015 and 2018, patients with NSTI at a quaternary referral center were followed up for the outcomes of death, limb loss, and streptococcal toxic shock syndrome. Surgical wound cultures and resistance data were obtained within 48 hours of admission as part of routine care. Risk ratios for the association between these outcomes and the presence of β-hemolytic streptococci or clindamycin-resistant β-hemolytic streptococci were calculated using log-binomial regression, controlling for age, transfer status, and injection drug use–related etiology. Results Of 445 NSTIs identified, 85% had surgical wound cultures within 48 hours of admission. β-Hemolytic streptococci grew in 31%, and clindamycin resistance was observed in 31% of cultures. The presence of β-hemolytic streptococci was associated with greater risk of amputation (risk ratio, 1.80; 95% confidence interval, 1.07–3.01), as was the presence of clindamycin resistance among β-hemolytic streptococci infections (1.86; 1.10–3.16). Conclusions β-Hemolytic streptococci are highly prevalent in NSTIs, and in our population clindamycin resistance was more common than previously described. Greater risk of limb loss among patients with β-hemolytic streptococci—particularly clindamycin-resistant strains—may portend a more locally aggressive disease process or may represent preexisting patient characteristics that predispose to both infection and limb loss. Regardless, these findings may inform antibiotic selection and surgical management to maximize the potential for limb salvage.

Radiographic imaging

2015 ◽  
Author(s):  
Emma L. Rowbotham ◽  
Andrew J. Grainger
Keyword(s):  
Imaging Modality ◽  
Plain Film ◽  
Conventional Radiography ◽  
Radiographic Imaging ◽  
Connective Tissue Disorders ◽  
Early Disease ◽  
Neuropathic Arthropathy ◽  
Cross Sectional ◽  
Plain Film Radiography ◽  
Cross Sectional Imaging

Plain film radiography is often the first imaging modality employed in the assessment of patients with a rheumatological condition. More recently this has been superseded by cross-sectional imaging, in particular ultrasound and MRI, which have improved sensitivity in detection of early disease when compared with plain film imaging. However, there remains a role for conventional radiography in both the initial diagnosis and monitoring of disease progression. A standard approach to assessing radiographs in the context of arthropathy is usually employed by radiologists; by following this structured review a diagnosis or narrow differential may be reached on plain film imaging alone. Plain film radiograph findings of the most common rheumatological disorders are covered in detail in this chapter including osteoarthritis, the inflammatory arthritides, and crystal arthropathy. Findings in the connective tissue disorders are then covered, followed by less commonly encountered conditions such as SAPHO, neuropathic arthropathy, and haemochromotosis.

scholarly journals  Hypertrophic osteopathy in a dog associated with intra-thoracic lesions: a case report and a review

2011 ◽  
Vol 56 (No. 12) ◽  
pp. 595-601 ◽  
Author(s):  
MA Cetinkaya ◽  
B. Yardimci ◽  
C. Yardimci
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Bone Formation ◽  
Disease Process ◽  
Radical Mastectomy ◽  
New Bone Formation ◽  
Cross Sectional ◽  
Hind Limbs ◽  
Metatarsal Bones ◽  
Periosteal New Bone Formation

This paper reviews hypertrophic osteopathy and describes one case report. Hypertrophic osteopathy is a rare pathologic disease process and is observed secondary to a mass in the thorax. In response to the presence of a mass(es), nonoedematous soft tissue swellings and a diffuse periosteal new bone formation develop in all four limbs. The result is mild to severe lameness. A twelve-year-old sexually intact female Cocker spaniel had undergone radical mastectomy on both sides in another veterinary hospital about two years before presentation in our hospital with lameness of both hind limbs. Pain and soft tissue swelling on the distal parts of extremities were determined in clinical examinations. Radiographs revealed periosteal new bone formation on all the long bones of all four limbs, pelvis and sternum; additionally, intrathoracic masses were observed. Euthanasia was performed five months later. Macroscopic examinations of the lungs revealed diffuse and exuberant masses with grizzled whitish cross-sectional colour and with necrotic and haemorrhagic foci. The radius-ulna, tibia, metacarpal and metatarsal bones of both limbs were examined and collected after the necropsy examination. Bone specimens were thicker and the outer surfaces seemed to be rough. At the histopathologic examination of the lung tissue, ovoid or round shaped and hyperchromatic nucleated diffuse anaplastic mammary gland epithelial cells were observed. According to these findings, these masses were diagnosed as the metastasis of malignant mixed tumours.  

scholarly journals Elastofibroma dorsi: The clunking tumour that need not cause alarm

2016 ◽  
Vol 98 (03) ◽  
pp. 208-211 ◽  
Author(s):  
HG Smith ◽  
JAF Hannay ◽  
K Thway ◽  
C Messiou ◽  
MJF Smith ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcomas ◽  
Percutaneous Biopsy ◽  
Surgical Excision ◽  
Electronic Patient Records ◽  
Cross Sectional ◽  
Female Ratio ◽  
Cross Sectional Imaging ◽  
Soft Tissue Masses ◽  
Pathology Reports

Introduction Elastofibromas are rare, pseudo-tumours arising at the inferior pole of the scapula that have a characteristic presentation. Due to their tissue of origin and size, they may often be mistaken for soft tissue sarcomas. We present the management of patients diagnosed with elastofibroma at a single institution. Methods Patients diagnosed with elastofibroma between January 1995 and January 2015 were identified from a prospectively maintained histopathology database. Electronic patient records, imaging and pathology reports were retrieved and reviewed. Results Thirty seven patients were identified, with a median age of 66 years and a male-to-female ratio of 1:1.6. All tumours occurred in the characteristic subscapular location. The median maximum tumour diameter was 8.2cm. A synchronous contralateral lesion (15.8%) was found in six patients. Cross-sectional imaging was performed in 29 patients, with magnetic resonance imaging the most common modality (59.5%). Diagnosis was confirmed with percutaneous biopsy in all but one patient, who proceeded directly to surgery. Eighteen patients were managed non-operatively; 19 opted for surgical excision due to significant symptoms. Excision was performed in a marginal fashion and, at a median follow-up of 5 months, no functional impairment or local recurrences were observed. Conclusions Soft tissue masses greater than 5cm in diameter should prompt the clinician to exclude soft tissue sarcoma. The diagnosis of elastofibroma may be alluded to by its typical presentation and can be confirmed by percutaneous biopsy. After excluding malignancy, these lesions can be safely managed non-operatively, with surgery reserved for symptomatic patients.

scholarly journals Imaging review of the anterior skull base

2018 ◽  
Vol 7 (5) ◽  
pp. 205846011877648 ◽  
Author(s):  
Olivia Francies ◽  
Levan Makalanda ◽  
Dimitris Paraskevopolous ◽  
Ashok Adams
Keyword(s):  
Soft Tissue ◽  
Nasal Cavity ◽  
Skull Base ◽  
Paranasal Sinuses ◽  
Anterior Skull Base ◽  
Normal Anatomy ◽  
Radiological Findings ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

The anterior skull base (ASB) is intimately associated with the unique soft tissue subtypes of the nasal cavity, paranasal sinuses, orbits, and intracranial compartment. Pathology involving the ASB is rare but the causes are manifold and can be broadly subdivided into those intrinsic to the skull base and processes extending from below or above. Sinonasal pathology is the most commonly encountered and poses significant management challenges that rely heavily on accurate interpretation of the radiological findings. We illustrate the normal anatomy of the ASB and present a cross-sectional imaging review of the pathological entities that may be encountered, focusing on the specific features that will impact on clinical and surgical management.

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