47 year old IV drug user in jugular vein with ipsilateral Calvarial osteomyelitis

Posted By Raman Nohria
47 year old IV drug user in jugular vein with ipsilateral Calvarial osteomyelitis

Plain film radiography of the chest revealed multiple linear objects consistent with broken needle fragments, including one running in parallel to the jugular venous system in the left lateral neck. Axial brain MRIs demonstrate A)scalp cellulitis, myositis, and abscess seen superiorly and B) osteomyelitis and subdural extension seen inferiorly. Osteomyelitis was treated with craniectomy and antibiotics.

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  • Raman Nohria 2014-09-15 15:03:16

    The patient was immunocompotent.



    Though no albumin level is available, patient had a BMI of 20 on presentation. He was also able to perform all adls and iadls independently.



    Abscess grew MRSA.

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  • Deepak Batura 2014-09-14 15:50:03

    Was the patient's immune status and nutritional status altered? What was the organism cultured from the abscess material?

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  • Raman Nohria 2014-09-13 22:47:46

    The needles/foreign bodes were left in place.



    The patient was managed first surgically and then with antibiotics. Surgically, the patient received a left-sided craniectomy with washout and temporary drainage catheter placement, and surgical cranioplasty and duroplasty with metallic mesh placement.



    Osteomyelitis resolved with antibiotic course. No biopsy was necessary.



    Follow up images are available - is there a way to add them to the current case?

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  • Tony 2014-09-13 18:57:16

    What was done? Surgical/interventional removal of foreign bodies?

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  • Roland Talanow 2014-09-13 18:56:09

    I assume that linear density in the left lateral neck is the described needle (no arrow pointed at).

    Osteomyelitis proven by biopsy or resolved with antibiotics? Follow up images available?

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