BMJ case reports
-
An epidural abscess represents a rare acute medical emergency, with a reported incidence of 2.5/10 000 hospital admissions annually. The clinical features include fever, spinal pain, radiating nerve root pain and leg weakness. When sepsis is present, prompt recognition is required to initiate appropriate antimicrobial therapy and surgical decompression. ⋯ With spinal surgical services centralised, physicians may not encounter this clinical diagnosis more often in day-to-day hospital medical practice. The unique aspect of this case is the persistence and then the recurrence (despite 6 weeks of antimicrobial therapy and a second debridement) of S. aureus infection. Furthermore, the paucity of clinical recommendations and the controversy regarding the adequate duration of antimicrobial therapy are notable features of this case.
-
Case Reports
Traumatic haemopneumothorax and 'whole-body' subcutaneous emphysema: successful use of a small-bore chest drain.
A 56-year-old man presented having had two falls at home. He had a background of multiple sclerosis. After his second fall, during which he had fallen onto the toilet injuring his right chest, he was brought into the emergency department reporting pleuritic chest discomfort. ⋯ It also showed right-sided rib fractures and associated haemothorax. He was managed conservatively with a 12-French (F), small-bore, chest drain and made a complete recovery without complication. This case challenges the widely held, but poorly evidenced, opinion that traumatic haemopneumothorax needs to be managed with a large-bore surgical chest drain.