PMC9860412_01
Photograph of the oil-stained plastic box that the patient got injured against.
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A healthy 23-year-old man struck his left palm on the corner of an oil-stained plastic box while reflexively reaching out to retrieve it (Figure 1).
Photograph of the left palm puncture site. There was a 7-mm crusted contusion on his left palm.
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There was a 7-mm crusted contusion on his left palm and swelling in the dorsum of the left hand without erythema or heat (Figure 2).
Blood test results. White blood cell counts were not elevated, and the C-reactive protein (CRP) was mildly elevated. Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score* was 0 points.*The LRINEC score is a robust score capable of detecting even clinically early cases of necrotizing fasciitis. Patients with a LRINEC score of >=6 should be carefully evaluated for the presence of necrotizing fasciitis. Four points are given if the patient's CRP is >=15 mg/dL, while 0 points are given if the patient's CRP <15 mg/dL. Two points are given if the patient's leukocyte count is >25x109/L, 1 point is given if the patient's leukocyte count is 15-25 x109/L, and 0 points are given if the patient's leukocyte count is <15x109/L. Two points are given if the patient's hemoglobin is <11 g/dL. One point is given if the patient's hemoglobin is 11-13.5 g/dL, and 0 points are given if the patient's hemoglobin is 13.5 g/dL. Two points are given if the patient's sodium level is <135 mmol/L, while 0 points are given if the patient's sodium level is >=135 mmol/L. Two points are given if the patient's creatinine level is >141 mmol/L, while 0 points are given if the patient's creatinine level is >=141 mmol/L. Lastly, 1 point is given if the patient's glucose is >10 mmol/L, while 0 points are given if the patient's glucose is >=10 mmol/L.
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Risk Indicator for Necrotizing Fasciitis (LRINEC) score was 0 points (Figure 3). Radiographs and contrast-enhanced computed tomography (CT) showed no fracture, pneumothorax, or soft tissue infection.
Plain radiograph of the left palm (a), the left axilla (b), and the left forearm (c). Air was distributed from the left palm to the left axilla.
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Air was distributed along the neurovascular bundle in the deep skin layer from the left upper limb to the axilla (Figure 4(a-c), Figure 5(a-d), Figure 6).
The contrast-enhanced computed tomography image.(a) plain mediastinal window setting (b) pulmonary window setting (c) and (d) equilibrium phase mediastinal window setting Air distributed along the neurovascular bundle was seen deep in the skin from the left upper limb to the axilla.
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Air was distributed along the neurovascular bundle in the deep skin layer from the left upper limb to the axilla (Figure 4(a-c), Figure 5(a-d), Figure 6).
Reconstruction of the contrast-enhanced computed tomography image. Blue area is air. Air distribution was mainly in the subcutaneous area, with deeper distribution between the fascia and along the neurovascular bundle.
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Air was distributed along the neurovascular bundle in the deep skin layer from the left upper limb to the axilla (Figure 4(a-c), Figure 5(a-d), Figure 6).