SUBESCAPULAR ABSCESS IN A 7-YEAR-OLD CHILD AFTER TRAUMA BY HORSE FALL: CASE REPORT

• DOI: 10.22533/at.ed.1592692215111

• Palavras-chave: abscesses; subscapularis; sepsis; resistance; MRSA

• Keywords: abscesses; subscapularis; sepsis; resistance; MRSA

• Abstract:

  Introduction: Subscapular abscesses in children are extremely rare. The subscapular space, comprised between the anterior surface of the scapula and the posterior surface of the rib cage, is an anatomical area that sometimes makes clinical assessment difficult. Therefore, as the subscapular abscess is an involvement that can lead not only to an accelerated deterioration of the patient, but also to death from sepsis, its early diagnosis and treatment are essential. Goals:  the current literature presents only seven studies of abscesses formed in the subscapular region. Thus, given the rarity of such an event and the scarcity of scientific evidence to guide the treatment, the present report aims to describe the diagnostic methods and the conduct applied in the case in question. Materials and Methods: K.H.P.N., 7 years old, was admitted to the University Hospital of UFJF febrile and with pain and swelling in the back and right shoulder after eight days of trauma from a fall from the horse. The patient was then submitted to an X-ray - without alterations - and, later, to an MRI, which showed fluid collections in the subscapular region. In addition, a blood count was performed, which showed marked elevations in the CRP and VSH meters, favoring the diagnosis of subscapular pyomyositis. The patient was referred to the operating room for drainage of the abscess and collection of material for bacteriological culture. Results: The antimicrobial susceptibility test identified Methicillin-resistant Staphylococcus aureus (MRSA) as the cause of the infection. That said, antibiotic therapy was started and after 10 days the patient was discharged with complete recovery. Conclusion: Early diagnosis of a subscapular abscess is essential in promoting better outcomes for the affected patient. Therefore, the magnetic resonance exam combined with laboratory tests is configured as the fundamental tools in the analysis of the lesion. In view of the fatal potential, establishing subscapular abscess as a differential diagnosis in cases of pain complaints in the shoulder and scapular region in febrile patients is of paramount importance.