SHM Converge Scientific Abstract ePoster Gallery-Sprung a Leak

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This case describes a 70-year-old woman with morbid obesity and non-alcoholic steatohepatitis cirrhosis who was transferred after a variceal GI bleed. She had received IV fluids and blood products at an outside hospital, and during transfer was given an intramuscular antiemetic in the left gluteus. On arrival, she had significant lower-extremity edema and later developed persistent leakage of clear yellow fluid from the injection site, severe enough to require an ostomy bag.<br /><br />Fluid analysis showed a hypocellular sample with protein similar to serum, suggesting simple transudative seepage rather than infection or a fistula. Point-of-care ultrasound of the area demonstrated a “cobblestone” appearance of the subcutaneous tissue, consistent with edema and fluid tracking between fat lobules, and did not show an abscess or fistulous tract. The leakage was attributed to severe anasarca worsened by transfusion and IV fluid administration, with local skin trauma from the intramuscular injection creating a focal site for fluid escape.<br /><br />The patient was treated with aggressive diuresis, and the fluid leakage resolved over the next two days.<br /><br />The discussion emphasizes that hospitalists should consider a broad differential for cutaneous fluid leakage, including low oncotic pressure states (such as cirrhosis or nephrotic syndrome), high hydrostatic pressure states (such as heart failure or venous obstruction), capillary leak syndrome, lymphatic impairment, and less common causes like abscesses or fistulas. This case highlights how bedside fluid studies and POCUS can help confirm edema, exclude more serious diagnoses, and avoid unnecessary invasive testing.

Asset Subtitle

Emily Hamburger

Meta Tag

Author List Emily Hamburger, Erin FInn, John R. Stephens, Nicholas Piazza

Category Clinical Vignettes

Concept Cutaneous Fluid Leakage

Concept Low Oncotic Pressure

Concept High Hydrostatic Pressure

Concept Systemic Capillary Leak Syndrome

Concept Lymphatic Impairment

Distinguished Non-Finalist

Presenter Organization UNC Internal Medicine

Presenting Author Emily Hamburger

Track Adult

Keywords

cirrhosis

anasarca

intramuscular injection

cutaneous fluid leakage

transudative seepage

variceal gastrointestinal bleed

point-of-care ultrasound

cobblestone appearance

edema

diuresis

Cutaneous Fluid Leakage

Low Oncotic Pressure

High Hydrostatic Pressure

Systemic Capillary Leak Syndrome

Lymphatic Impairment