Ultrasound Visualization of Atypical Abscess Ultimately Containing Bot Fly Larva

Abstract

BackgroundBecause of the rise in community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), presentations to the emergency department for the evaluation of cutaneous abscesses have risen dramatically over the past 2 decades. Soft tissue point of care ultrasound (POCUS) differentiates abscess from cellulitis, determines the size and shape, and characterizes the contents of the abscess. It has been shown to improve medical decision-making and therefore the emergency management of cutaneous abscesses over physical examination alone. Case ReportWe report a case of an unusual nonhealing abscess in an 18-year-old woman with a recent history of foreign travel where soft tissue POCUS identified motion within the abscess pocket. This changed the management of the case, leading to the diagnosis of bot fly myiasis. Why Should an Emergency Physician Be Aware of This?Clinicians should entertain a broader differential for an apparent abscess and consider liberal use of soft tissue POCUS in these cases.