SHIN ABCESS FOR DRAINAGE
A 59 yo male with lump on right leg for 3/52 complaining of increasing pain, redness and swelling.
GP attempted needle aspiration without success so referred to ED.
Patient was afebrile with a 4cm diameter fluctuant tender red swelling on the right shin with the classical clinical appearance and feel of an abcess.
ENP who had earlier undergone offsite training in POCUS at my encouragement requested an US of the swelling to determine extent of abcess. ENP reported that the swelling "looked odd” and “not like an abcess.”
The patient in this case was not sick or shocked but it highlights the clearly altered Dx & Mx and the fact that all ED clinical staff can use POCUS!
• The diagnosis was actually subcutaneous traumatic calcification from career as a jockey with impacts to shins (haematomas causing calcification similar to myositis ossificans effect)
• This case reinforced that accuracy of clinical Dx of painful red tender swelling as either cellulitis or abcess is frequently incorrect. Studies tell us that clinicians are wrong 1/3 of the time
• Incision and drainage when thought to be an abscess but is actually cellulitis causes unnecessary pain to the patient
• Antibiotics alone for cellulitis when there is an abscess is usually going to delay improvement as the pus needed drainage
•Never stick a needle or scalpel into a lump without US first and use colour to assess for flow. An abcess has no flow
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