Usman Faisal, Bajwa Abubakr, Shujaat Adil, Cury James
Department of Pulmonary & Critical Care, University of Florida College of Medicine, 655 West 8th Street, Jacksonville, Fl, USA 32209.
J Med Case Rep. 2011 Aug 23;5:403. doi: 10.1186/1752-1947-5-403.
Although retrosternal abscess is a well known complication of sternotomy and intravenous drug abuse, to date it has not been described as a consequence of trigger point injections. There are reported cases of serious complications as a result of this procedure including epidural abscess, necrotizing fasciitis, osteomyelitis and gas gangrene.
A 37-year-old African-American woman, who was 20 weeks pregnant, presented to our emergency room with complaints of progressively worsening chest pain and shortness of breath over the course of the last two months. She was undergoing trigger point injections at multiple different sites including the sternoclavicular joint for chest pain and dystonia. Two years previously she had developed a left-sided pneumothorax as a result of this procedure, requiring chest tube placement and subsequent pleurodesis. Her vital signs in our emergency room were normal except for resting tachycardia, with a pulse of 100 beats per minute. A physical examination revealed swelling and tenderness of the sternal notch with tenderness to palpation over the left sternoclavicular joint. Laboratory data was significant for a white blood count of 13.3 × 109/L with 82% granulocytes. A chest radiograph revealed left basilar scarring with blunting of the left costophrenic angle. A computed tomography angiogram showed a 4.7 cm abscess in the retrosternal region behind the manubrium with associated sclerosis and cortical irregularity of the manubrium and left clavicle.
Trigger point injection is generally considered very safe. However, there are reported cases of serious complications as a result of this procedure. A computed tomography scan of the chest should strongly be considered in the evaluation of chest pain and shortness of breath of unclear etiology in patients with even a remote history of trigger point injections.
虽然胸骨后脓肿是胸骨切开术和静脉药物滥用的一种已知并发症，但迄今为止，尚未有将其描述为触发点注射后果的报道。有报道称该操作会导致包括硬膜外脓肿、坏死性筋膜炎、骨髓炎和气性坏疽在内的严重并发症。
一名37岁的非裔美国女性，怀孕20周，因在过去两个月中胸痛和呼吸急促逐渐加重而前来我院急诊室就诊。她正在多个不同部位接受触发点注射，包括用于胸痛和肌张力障碍的胸锁关节。两年前，她因该操作导致左侧气胸，需要放置胸管并随后进行胸膜固定术。在我院急诊室，她的生命体征除静息心动过速（脉搏每分钟100次）外均正常。体格检查发现胸骨切迹肿胀压痛，左侧胸锁关节触诊压痛。实验室数据显示白细胞计数为13.3×10⁹/L，粒细胞占82%。胸部X线片显示左肺底部瘢痕形成，左肋膈角变钝。计算机断层血管造影显示在胸骨柄后方的胸骨后区域有一个4.7厘米的脓肿，伴有胸骨柄和左锁骨的硬化及皮质不规则。
触发点注射一般被认为非常安全。然而，有报道称该操作会导致严重并发症。对于有触发点注射史（即使是远期）且病因不明的胸痛和呼吸急促患者，在评估时应强烈考虑进行胸部计算机断层扫描。
