Dr. Richard on Armpits, Metal Rods, Pus, and T-shirts

Here’s a neat case from Dr Bernard Richard from Valleyfield in la belle province…

A 30 y.o. man fell on a metal rod a week ago. He was seen in the ED and had his 10 cm right axillary wound sutured. I saw him a week later for 4 cm lump that was located 15 cm below the wound (!) and near the elbow. I put the probe on the lump and saved these images:

There is a hyperechoic curved line with mild refraction artifact and a possible collection of fluid just to the right of it. An X-ray was negative for any metallic or other foreign body; there was just a little bubble of air.

Using POCUS, I marked the skin and incised the lump. After evacuating a lot of pus, given the findings on ultrasound, I probed for a foreign body and found the cause of the hyperechoic curved line:

A small piece of his T-shirt that was pushed far from the wound during the accident. This foreign object caused the abscess and would not have been easily found (or searched for!) without POCUS. Lots of trouble saved for the patient!