Intramuscular Air as a Complication of Pulse-Lavage Irrigation

Abstract

Intramuscular air in the setting of infection can be an indicator of a rapidly escalating and potentially life-threatening infection, such as gas gangrene or necrotizing fasciitis. For a patient with diffuse pain in an extremity and air in the tissue planes as seen on imaging studies, surgical exploration has been strongly recommended1-6. Iatrogenic causes of air in fascial planes are underreported. We present the case of a child with septic arthritis of the hip that was treated with open irrigation and debridement by the on-call service. There was temporary use of pulse lavage during the operation, resulting in intramuscular and subfascial air. The following day, the medical team that accepted the patient from the on-call service had no knowledge of the use of pulse lavage and, when confronted with a confusing clinical picture and dramatic radiographs, proceeded with urgent surgical exploration. This case demonstrates an iatrogenic cause of intramuscular air and illustrates the importance of good communication between on-call and accepting services. In accordance with local Human Resources and Research Center (institutional review board) policies, the parents of the patient were informed that data concerning the case would be submitted for publication, and they consented. A ten-year-old boy presented with a history of decreasing ability to walk over a period of five days prior to presentation and fever of as much as 102° F (38.9° C). He was described as a previously healthy young man except for mild asthma, which was well-controlled with albuterol and Flovent (fluticasone propionate) inhalers. There was no history of trauma or injury. The examination was notable for an inability to bear weight on the right lower extremity, and the elicitation of pain with passive range of motion of the hip. There was no pain or swelling in the thigh, knee, or …