A RARE CASE OF METHICILLIN-RISISTANT STAPHYLOCOCCUS AUREUS EMPYEMA NECESSITANS VISUALIZED ON POINT-OF-CARE ULTRASOUND

TOPIC: Imaging TYPE: Medical Student/Resident Case Reports INTRODUCTION: Empyema necessitans is a rare complication of bacterial pneumonia that occurs when empyema invades the parietal pleura and extends into surrounding chest wall; if left unchecked it will eventually drain through skin. Here we present case in previously healthy 25 year-old man caused by MRSA pneumonia, visualized with bedside ultrasound. CASE PRESENTATION: This gentleman originally presented to an outside hospital two months worsening dyspnea, cough, pleuretic pain. He reported night sweats fever after recent upper respiratory infection. denied having any past medical conditions, however his social history endorses intravenous drug use. Prior final presentation he emergency department twice, being diagnosed costochondritis, discharged oral pain medications. was then treated courses antibiotics from urgent care. During this time began develop fluctuant erythematous anterior wall mass. At point again hospital, who obtained computed tomography (CT) scan chest, revealing large loculated pleural effusion concerning for may have been communicating transferred our facility evaluate complicated effusion. point-of-care ultrasound exam performed, showing heterogeneous, echogenic freely flowing across defect intercostal muscles directly mass, highly necessitans. A small tube placed, purulent fluid grew on culture, confirming diagnosis. Ultimately patient required surgical intervention decortication pleurectomy along vancomycin. DISCUSSION: Rapid identification crucial facilitate appropriate treatment, which often involves management, timely manor avoid morbidity mortality. CONCLUSIONS: POCUS hands trained clinician provides rapid, accurate, cost effective diagnostic approach those diagnosis REFERENCE #1: Elyashiv D, Alpert EA, Granat N. Necessitans Diagnosed Point-of-Care Ultrasound. J Emerg Med. 2020 Dec;59(6):e221-e223. doi: 10.1016/j.jemermed.2020.09.020. Epub Oct 13. PMID: 33059991. DISCLOSURES: Advisory Committee Member relationship EchoNous Please note: 11/12/2020 Added 04/30/2021 Keith Barron, source=Web Response, value=Ownership interest Stock ownership Butterfly IQ No relevant relationships Stephanie Scott, Response