Original article | Volume 26, Article 149, 15 Mar 2017 | 10.11604/pamj.2017.26.149.11393

Plain x-ray films in soft tissue infections

Diogo Carrola Gomes, Luísa Quaresma

Corresponding author: Diogo Carrola Gomes, Luísa Quaresma

Received: 11 Dec 2016 - Accepted: 19 Feb 2017 - Published: 15 Mar 2017

Domain: Clinical medicine

Keywords: Gas gangrene, x-ray, clostridium, soft tissue

©Diogo Carrola Gomes et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cite this article: Diogo Carrola Gomes et al. Plain x-ray films in soft tissue infections. Pan African Medical Journal. 2017;26:149. [doi: 10.11604/pamj.2017.26.149.11393]

Available online at: https://www.panafrican-med-journal.com/content/article/26/149/full

Home | Volume 26 | Article number 149

Original article

Plain x-ray films in soft tissue infections

Plain x-ray films in soft tissue infections

Diogo Carrola Gomes1,&, Luísa Quaresma1

 

1Serviço de Cirurgia 1, Centro Hospitalar Lisboa Central, Rua José António Serrano, 1150-199 Lisboa, Portugal

 

 

&Corresponding author
Diogo Carrola Gomes, Serviço de Cirurgia 1, Centro Hospitalar Lisboa Central, Rua José António Serrano, 1150-199 Lisboa, Portugal

 

 

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A 39-year-old male with a history of cocaine abuse presents to the emergency room with pain in the right leg and fever (39ºC) 6 days after injecting himself in the thigh with midazolam pills diluted in tap water to control symptoms of withdrawal. Physical examination revealed rubor, swelling and tenderness of the thigh without crepitation, suggestive of cellulitis. Laboratory findings consisted of a WBC of 10.700x106/L (86% Neutrophiles) and CRP of 170 mg/dL. An X-ray of the leg was performed, revealing a feathering pattern of gas within the soft tissue of the thigh indicative of gas gangrene. Intraoperatively, we found wide necrosis of the muscles and fatty tissue of the posterior thigh without substantial quantities of pus. An extensive debridement was performed and penicillin and clindamycin were administered for two weeks. Cultural exams revealed the presence of aerobic (Streptococcus mitis and Streptococcus oralis) and anaerobic bacteria (Clostridium clostridioforme and Prevotella oralis). The infection was controlled after further daily debridement and the wound was closed with the assistance of a negative-pressure wound therapy device. The patient was discharged from the hospital to a physical rehabilitation facility and regained most of his functional capacity. Gas gangrene is a life-threatening condition, misdiagnosis and failure of recognition in its early stages can prove fatal. Plain X-ray films are readily available in most hospitals and can provide significant information in patients with soft tissue infections where 'time is tissue'.

 

 

Figure 1: plain x-ray of the thigh demonstrating a feathering pattern indicative of the presence of gas in the soft tissue

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Original article

Plain x-ray films in soft tissue infections

Original article

Plain x-ray films in soft tissue infections

Original article

Plain x-ray films in soft tissue infections

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Gas gangrene

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Soft tissue

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