Rapid bedside diagnosis of pyomyositis with ultrasound-guided needle aspiration

Abstract

A 62-year-old male with a past medical history of cirrhosis presented to the emergency department with left thigh pain and swelling 2 weeks after trauma to the left lower extremity due to a ground level fall. On arrival, physical exam revealed significant edema, erythema and warmth of the left thigh concerning for infection. Point-of-care soft tissue ultrasound by the emergency physician revealed multiple complex fluid collections deep within the quadriceps muscle. Ultrasound-guided needle aspiration of these fluid collections was performed at the bedside while waiting for surgical consultation and MRI. Copious amounts of purulent fluid were aspirated prompting the early diagnosis of pyomyositis. Therapeutic management was expedited as a result of these findings. Point-of-care ultrasound is a valuable tool for the early and rapid detection of pyomyositis and can expedite definitive treatment.