Thursday, April 21, 2011


Inspired by the prior post on attack plants, this one is called cabbage. One week after an obese 60 year old gentleman gets a coronary artery bypass graft, he develops a temperature to 38.3 and pulse of 102. He complains of worsening sternal chest pain. The cross-covering intern checks a troponin, which is negative, and brushes off the fever, saying it's atelectasis. But you're not so sure - when you go examine the patient, you note purulent drainage around the median sternotomy site. When you auscultate the heart, you note a crunching sound that occurs with the heart beat. Palpation has a "Rice Krispie" feel. The patient's past medical history includes diabetes which has not been well controlled since his surgery.

Challenge: What's the clinical diagnosis? Blood cultures are positive for what organism?

Image is in the public domain, from Wikipedia.


Anonymous said...

Hammond's crunch; mediastinitis; staph

Craig Chen said...

nicely done!

This is post-CABG mediastinitis, and the most common organisms are Staphylococcus and Streptococcus. The crunching sound is called Hamman's sign; palpation demonstrates crepitus.

Source: UpToDate.