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Case 1: Shortness of Breath
Case 2
Post 1: Introduction Pt 1
Post 2: Introduction Pt 2
Post 3: Introduction Pt 3
Post 4: Bad Outcome Pt 1
Post 5: Bad Outcome Pt 2
Post 6: Legal Outcome
Post 7: Documentation Review
Post 8: Medical Review
The patient was admitted to the hospital.
In the hospital several hours later, an MRI of his thoracic spine was ordered. The results of the MRI are shown here:
By that time his lower extremities seem to have become completely paralyzed. The MRI shows a spinal cord lesion at the lower thoracic area. Given his paralysis, recent fever, back pain, and diabetes, this was felt to represent a spinal epidural abscess. A neurosurgical consultation was obtained, and is shown below for MedMalReviewer newsletter subscribers:
The patient underwent complete thoracic laminectomy at T7 and T8, and partial laminectomy at T9 with washout of an epidural abscess. Microbiology results show MSSA. Unfortunately, the patient was left with flaccid paralysis and sensory deficit at the T7 level. He was left with neurogenic bowel and bladder. Later during his hospital course he developed septic arthritis in his right shoulder and was taken to the operating room for washout. He also developed C diff, and was discharged on oral vancomycin in addition to his cefazolin and rifampin for MSSA.
