CHEST Guidelines-47-Year-Old-Woman-With-Altered-Mental-Status-and-L

47-Year-Old-Woman-With-Altered-Mental-Status-and-L

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A 47-year-old woman with cirrhosis, diabetes, neuropathy, and Charcot foot presented with worsened mental status and lower extremity edema lasting three days. Her vital signs were mostly normal, but a low sodium level of 113 and a high white blood cell count of 23,300 were observed. Despite treatment for sepsis, no infection source was initially identified. An ultrasound revealed an abscess in her lower extremity near an injury from a fall a month prior. A CT scan confirmed early abscess formation, leading to the involvement of multiple surgical teams. Methicillin-resistant Staphylococcus aureus (MRSA) was identified from purulent fluid aspiration, confirming the infection source. Her treatment delayed until detailed imaging and she ultimately underwent a below-knee amputation, resulting in improved leukocytosis.<br /><br />The article illustrates the importance and effectiveness of point-of-care ultrasound (POCUS) in diagnosing soft tissue infections. POCUS quickly evaluated the patient's edematous lower extremity, missing in previous examinations, leading to a timely diagnosis and proper surgical referrals. While MRSA is common in skin infections, determining the presence of an abscess is crucial for selecting treatment methods, as surgical drainage is necessary for abscesses while antibiotics are reserved for cellulitis. POCUS, despite being a less comprehensive imaging technique, was pivotal in this case and altered clinical management significantly, demonstrating a high sensitivity and specificity rate in identifying abscesses compared to clinical examinations alone.<br /><br />In conclusion, this case demonstrates how rapid POCUS application can effectively diagnose complex infections like abscesses, even when clinical suspicion is low, emphasizing its critical role in modern medical diagnostics and treatment planning. POCUS's swift results can lead to necessary intervention, as evidenced by the patient's outcome.

Keywords

cirrhosis

diabetes

Charcot foot

abscess

point-of-care ultrasound

MRSA

sepsis

surgical drainage

diagnosis

treatment planning