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[Multiple chest wall abscesses complicating blunt chest trauma].

A 62-year-old patient was admitted to the emergency department with a diminished level of consciousness after injuries received in a traffic accident. The patient had a respiratory rate of 18 breaths/min, a pulse rate of 82 beats/min, blood pressure of 120/70 mm Hg, and a score of 13 on the Glasgow Coma Scale. Findings from cardiocirculatory, respiratory, and abdominal examination were normal and peripheral pulses were present. The complete blood count and emergency biochemistry were also normal. A simple chest radiograph revealed multiple left rib fractures (the fifth to the ninth ribs), with no pleuropulmonary trauma. The computed tomography scan of the chest showed a subarachnoid hemorrhage in the right parietal region. The neurological status of the patient improved and became normal on the fourth day after admission. At day 5, the patient developed fever and dyspnea. Physical examination showed hypoventilation in the lung bases, and blood gas analysis showed a PaO2 of 54 mmHg, a PaCO2 of 27 mmHg, and a pH of 7.5. A chest radiograph revealed a left pulmonary base infiltrate and ipsilateral pleural effusion. Urine and blood cultures were started and treatment was initiated with ceftacidine and tobramycin. The patient was admitted to the intensive care unit intubated and mechanically ventilated with a positive end-expiratory pressure of 10 cm H2O; a PaO2 of 230 mm Hg was attained. Physical examination showed fluctuant masses measuring 3 and 5 cm, respectively, in the left parasternal region and located in the second and fourth intercostal spaces, without heat or erythema. Over the next few days, the patient’s clinical status gradually worsened, despite improved radiological findings for the pulmonary infiltrate and pleural effusion. Blood cultures showed the presence of Staphylococcus aureus and treatment with vancomycin was initiated. No other focus of infection was found, and both the electrocardiogram and the echocardiogram were normal. The masses previously detected in the chest wall increased in size and also presented clear signs of inflammation. At the same time, other collections were detected at the midaxillary line in the fourth, fifth and seventh intercostal spaces. Computed tomography confirmed bilateral involvement (figure). Needle biopsy of the collections confirmed the presence of the same pathogen as in the blood culture, and a needle biopsy of the pleural effusion found no infection. The abscesses were debrided; the patient improved and was discharged 15 days later.