case 1.2 answer

morrisons-pouch-redo2

Presented by Dr. Debia Kim

NICE JOB

Dan Seitz

Kyle Perry

Richard Gordon

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?case

Answers:

  1. Celluitis and abscess
  2. Images 1 and 3
  3. Lymph nodes

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.

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