PMC6287146_01
Skin exam on initial presentation, showing erythema at the inferior margin of the wound.
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In the emergency department, he was febrile to 102 degrees Fahrenheit, and his exam was notable for a warm, erythematous, and tender epigastrium without obvious wound dehiscence (Figure 1).
Computed tomography imaging with intravenous contrast showing nontyphoidal Salmonella mediastinal abscess. Panel (a) shows axial views, panel (b) shows coronal views, and panel (c) shows sagittal views at the time of presentation (left) and following 6 weeks of therapy with intravenous ceftriaxone (right).
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fig2
Computed tomography of the chest demonstrated a 13.6-centimeter rim-enhancing fluid collection in the anterior mediastinum with multiple small foci of gas, an additional 2.5-centimeter collection between the clavicular heads, and new skin thickening and soft-tissue stranding in the anterior chest wall concerning for soft-tissue infection (Figure 2). A repeat chest CT after completion of therapy showed no evidence of aortic involvement, a small amount of residual fluid, and sternal bony changes concerning for remodeling versus infection (Figure 2).