Case 1.2

morrisons-pouch-redo2

Presented by Dr. Debia Kim

47 y/o woman presents with pain and swelling in her right underarm for the past few days.  She says she first noticed an itchy “bug bite” in her armpit which gradually became larger but never “came to a head.”  She has not tried anything at home to relieve the pain, and her strength and range of motion are unaffected by the swelling.  No fevers/chills.  The patient has a history of DM2 and is a cigarette smoker.

Her physical exam reveals normal vital signs, and a 6cm x 4cm very tender, raised erythematous area of induration in the R axilla.  Peripheral pulses and neuro exam are normal.  No fluctuance.  You decide to do an ultrasound examination of the right (abnormal) underarm and also the left (normal) for comparison.

Image 1

Image 2

Image 3

Image 4

Questions:

  1. What is the diagnosis?
  2. Which images show pathology?
  3. What are the structures highlighted in the color-flow images?

Please post your answer in the “reply box” or click on the “comments” link  You will not see your answer post until next week when all of the submitted answers will be posted.  Good luck!

This case prepared by Dr Debia Kim, PGY-1 Emergency Medicine Resident, Detroit Receiving Hospital

“Morrison’s Pouch” is an educational module that utilizes ultrasound video clips from case presentations in the Emergency Department.

4 Responses

  1. 1. Abscess with surrounding cellulitis
    2. images 1 and 3
    3. lymph nodes

  2. Image 3 shows an area of fluctuation, probably an abscess. Image 4 shows the brachial artery and vein.

  3. diagnosis: focal cellulitis of affected area.

    image 1 : edema involving skin and subcutaneous tissue.
    image 2: multiple lymphnodes.
    image 3: measurment of lymphnode size not shown.
    image 4: vascularity with in the center of lymphnode suggestive of benignity.

  4. axillary lymphadenitis / possible mets from breast CA

    2,3,4

    image 4 shows vascular color flow in three of these masses, indicating that these are lymph nodes and not abscesses/hidradenitis.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: