A 52-year-old patient admitted to our hospital 1 month earlier with a severe SARS-CoV-2 infection (requiring admission to the intensive care unit and mechanical intubation for 2 weeks, where he was placed in the prone position for several cycles) complained of chest discomfort. Physical examination showed an indurated anterior chest wall scar (Figure 1 ). Anterior chest wall ultrasound (Figure 2 ) and thoracic computed tomography (Figure 3 ) were performed.
Figure 1.
Necrotic ulcer involving the left inframammary region.
Figure 2.
Ultrasound image (obtained with a high-frequency linear probe) of the indurated area of the anterior chest wall shows thickening of the skin (arrows) and heterogeneous increase in the echogenicity of the subcutaneous fat tissue (asterisk).
Figure 3.
Axial computed tomography image of the thorax shows subcutaneous fat stranding of the anterior chest wall (long arrows), a skin defect in the left inframammary region (asterisk), and lack of involvement of the rib cartilage and muscular planes (short arrows).
Diagnosis
Anterior chest wall fat necrosis in a patient with COVID-19following prolonged prone position. Prone position is frequently used in patients with respiratory failure, but this position can lead to complications, such as pressure ulcers.1 In general, there is a lack of knowledge among health care personnel for the prevention of pressure ulcers in patients with COVID-19 in the prone position, aggravated by the difficulty in mobilizing intubated patients in this position. Anterior chest wall pressure ulcers are rare, and imaging techniques can help to rule out the involvement of deeper structures.2 In the literature, to our knowledge, we have not found a radiological description of fat necrosis as a complication of prolonged prone position in a patient with COVID-19. Clinicians should be aware of the risk of pressure ulcers in the anterior chest wall in patients with COVID-19 placed in the prone position.
A biopsy of the indurated area confirmed fat necrosis. The patient was treated with local dressings and antiseptics and responded favorably to the treatment.
Footnotes
For the diagnosis and teaching points, see page e50.
To view the entire collection of Images in Emergency Medicine, visitwww.annemergmed.com.
References
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