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Miscellanea
Images in paediatrics
Benign muscular emphysema mimicking gas-forming infection
  1. Matthias Nissen1,
  2. Micha Bahr1,
  3. Volker Sander1,
  4. Werner Finke2,
  5. Ralf-Bodo Tröbs1
  1. 1 Department of Pediatric Surgery, St. Mary’s Hospital, St. Elisabeth Group, Ruhr-University of Bochum, Herne, Germany
  2. 2 Department of Anesthesiology and Surgical Intensive Care, St. Mary’s Hospital, St. Elisabeth Group, Ruhr-University of Bochum, Herne, Germany
  1. Correspondence to Dr. Matthias Nissen, Department of Pediatric Surgery, St. Mary’s Hospital, St. Elisabeth Group, Ruhr-University of Bochum, Herne D- 44627, Germany; matthias.nissen{at}elisabethgruppe.de

https://doi.org/10.1136/archdischild-2018-316219

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    A 13-year-old boy presented 24 hours after noticing an insect bite on his left forearm (figure 1A). Perilesional erythema with a blister, crepitation and progressive pain started 12 hours before presentation. On admission, vital signs, inflammatory parameters, creatinine (kinase) and lactate were normal. Left arm and ventral hemithorax were swollen with crepitation, chest physical examination was unremarkable. CT showed subfascial emphysema (figure 1B).

    Figure 1

    (A) Insect bite with perilesional erythema on the left forearm. (B) Non-enhanced CT depicting gas …

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    Footnotes

    • Contributors The authors were all involved in treatment of patient. MN performed data collection, analysis and article writing. R-BT performed surgery and contributed to critical revision. WF performed anesthesia and provided pictures. MB, VS and WF contributed to critical revision.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Parental/guardian consent obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.