1 - Serviço de Cirurgia Pediátrica, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
- Apresentação no mesa “Os melhores” na 8ª Reunião da EUSPP/23º Congresso da SPCP – Urgência e Emergência Pediátrica, Évora
Introduction: The sternocleidomastoid (SCM) muscle is a common site for muscle strain and soreness, but spontaneous infection of this muscle after closed trauma is a rare condition.
Case report: 15-year-old patient with pain, swelling and pus drainage from the left supra-clavicular area. The patient had a minor lesion of the left SCM after a strain injury. A small intra-muscle hematoma developed and two days after, the patient started to show erythema, increased pain, swelling, and was seen in a private institution. At that time, oral antibiotic treatment was initiated with no other measures taken. At the 3rd day of treatment there was no improvement, and a cervical MRI was requested. After the result the patient was transferred to our institution. He presented febrile, tachycardic, with spontaneous projectile release of purulent fluid through the lesion. Blood work with white count 28.000x 10^9/L and CRP of 300 mg/L. Previous MRI showed a supraclavicular abscess with 13cm, extending to the superior mediastinum. The patient was taken to the OR for cleaning and debridement. The result was a complete destruction of the clavicular branch of the SCM with an extended abscess to the superior mediastinum that was cleaned thoroughly. Samples of purulent tissue and liquid were collected; Streptococcus intermedius was isolated. A difficult process of healing with multiple vacuum dressings was applied and after fifteen days of treatment, the patient was submitted to a complete thickness skin graft. In 5 days was discharged and dressings in an out-patient clinic were maintained until full healing was achieved.
Discussion: The exact cause of Spontaneous SCM infection is not well understood, and there is only a few case reports of these condition. Diagnosis can be challenging. Imaging studies may be necessary to confirm the diagnosis but should not delay adequate treatment. Prompt and appropriate treatment is essential to prevent serious complications such as sepsis and mediastinitis.
Conclusion: Spontaneous SCM infection is a rare but potentially serious condition. If left untreated can lead to high mortality and morbidity conditions such as mediastinitis and complex cervical wounds.
Palavras Chave: Infeção, Esternocleidomastoideu, Espontânea, Enxerto