11institutetext: Knowledge-based Systems and Document Processing Research Group Faculty of Computer Science Otto-von-Guericke-University Magdeburg 11email: katrin.krieger@ovgu.de
Investigations:
A preliminary diagnostic workup of the patient revealed several concerning findings: creatinine was slightly elevated at 1.4 mg/dL (normal range: 0.8-1.3 mg/dL), bicarbonate was below normal at 18.5 mmol/L (normal range: 22-29 mmol/L) and PCO2 also, indicative of metabolic acidosis. The CRP level, indicating inflammation, was markedly elevated at 398 mg/L (normal range: 0-10 mg/L). A complete blood count (CBC) showed anemia as hematocrit and RBC were reduced, and a notable elevation in white blood cell count to 15 x10^9/L (normal range: 4.8-11.3 x 10^9/L). Specifically, neutrophils were significantly elevated at 83.4% (normal range: 34.9-76.2%), while lymphocytes were severely decreased to 7% (normal range: 17.5-45%). Subsequent liver function tests (LFTs) showed elevated levels of total bilirubin (2.1 mg/dL; normal range: 0.1-1.2 mg/dL) and direct bilirubin (1.5 mg/dL; normal range: 0-0.2mg/dL). Glucose levels were also consistently elevated. Pus culture came back positive for Methicillin-Resistant Staphylococcus aureus. CT Head and Neck with contrast showed extensive soft tissue swelling on the left anterior chest wall with active contrast excavation, representing hematoma with active bleed for which the patient underwent successful embolization of pseudo aneurysm arising from the left internal thoracic artery by Histoacryl glue (Figure 1). A core biopsy of an anterior mediastinal mass was also done to rule out that the mass was not due to any underlying malignancy and granulomatous disease. Biopsy revealed severe acute and chronic inflammation, abscess formation and granulation tissue suggestive of an infectious etiology (Figure 2). A CT chest with contrast was performed that revealed heterogeneous enhancing soft tissue identified in the left sternocleidomastoid muscle, extending infero laterally along the subcutaneous tissues of the left anterior chest wall (Figure 3). There was also deep extension into the left upper lobe and superior mediastinum via the thoracic inlet, causing the contralateral tracheal shift that diagnosed it as a case of Sternoclavicular Septic Arthritis. Furthermore, a limited Ultrasound of the arm also revealed significant subcutaneous edema in the left upper limb.