Mourkus Hany, Vadivelu Ramanan, Phillips James
Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
Eur J Orthop Surg Traumatol. 2018 Aug;28(6):1235-1240. doi: 10.1007/s00590-018-2156-4. Epub 2018 Feb 10.
Subscapular space is an uncommon site for abscess formation. There are only seven reports of subscapular abscesses in the literature. Only three of these cases are reported in children. We recently treated a child with subscapular abscess. We performed the literature search using a combination of the keywords: subscapular, scapular, abscess and infection. One case was diagnosed on post-mortem autopsy, and only three of these cases are reported in children. The organism was Staphylococcus aureus in five cases (two were methicillin-resistant S. aureus), Haemophilus influenzae in one case, and no organism was grown in the last case. (Patient received a course of empirical antibiotics and samples did not grow any organism.) We describe a case of spontaneous subscapular abscess in a 7-year-old boy. The abscess was visualised on magnetic resonance imaging (MRI), and the organism was identified as S. aureus bacteria. The abscess was treated surgically with debridement and antibiotics, and the patient had full recovery with no subsequent effects. Subscapular abscess needs high index of suspicion and early imaging investigation. MRI is the modality of choice for accurate diagnosis. Early intervention leads to favourable outcome, while delays in diagnosis can be fatal.
肩胛下间隙是脓肿形成的罕见部位。文献中仅有7例肩胛下脓肿的报道。其中仅有3例为儿童病例。我们最近治疗了一名患有肩胛下脓肿的儿童。我们使用“肩胛下”“肩胛骨”“脓肿”和“感染”等关键词组合进行了文献检索。1例在尸检时被诊断,其中仅有3例为儿童病例。5例的病原体为金黄色葡萄球菌(2例为耐甲氧西林金黄色葡萄球菌),1例为流感嗜血杆菌,最后1例未培养出病原体(患者接受了经验性抗生素疗程,样本未培养出任何病原体)。我们描述了一名7岁男孩自发性肩胛下脓肿的病例。脓肿在磁共振成像(MRI)上显影,病原体被鉴定为金黄色葡萄球菌。脓肿通过清创术和抗生素进行手术治疗,患者完全康复且无后续影响。肩胛下脓肿需要高度怀疑并尽早进行影像学检查。MRI是准确诊断的首选检查方式。早期干预可带来良好预后,而诊断延迟可能是致命的。