Pyomyositis: look below the fascia

Question 1What is pyomyositis?

1. aA muscle tear
2. bInfection of the skin only
3. cA clot in a deep vein
4. dBacterial infection within skeletal muscle, which can form an abscess

Question 2How does normal muscle look?

1. aDark, with fine bright striations and bright fascial lines
2. bBright, with an acoustic shadow
3. cBlack, like fluid
4. dUniformly bright with no structure

Question 3Which finding raises concern for pyomyositis?

1. aMuscle with clear, normal striations
2. bA bright cortex with a shadow
3. cCobblestoning in the fat only
4. dA complex pocket inside the muscle, below the fascia

Question 4In early disease, a near-normal scan means:

1. aThe patient can safely go home
2. bInfection is not excluded: image further if the picture fits
3. cThe pain is not muscular
4. dNo antibiotics are needed

Question 5What should you do once pyomyositis is suspected?

1. aRepeat the scan in a month
2. bMassage the muscle
3. cAspirate blind in the emergency department
4. dBlood cultures, MRI or CT for the extent, and surgical review for drainage