Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The abscess that surprised this emergency physician

Raj Waghmare, MD
Conditions
June 1, 2017
186 Shares
Share
Tweet
Share

I carried it around with me the entire shift. I showed it to my E.R. colleagues, the internists, and even a couple of surgeons. I’d tell them the story. “Never,” one of them said. “Not in twenty-eight years. Never seen that before.”

One of them held the small urine jar up to a light and began unscrewing the lid.

“Don’t!” I said.

“Why not?”

“It stinks. You wouldn’t believe how much it stinks. We aerosolized the room and closed the door. You could still smell it for hours. It’s awful. Putrid.”

“Abscess” was the presenting complaint. There’s something satisfying about draining an abscess. It’s one of the few procedures that can provide instant relief to the patient. Sandra Lee, the dermatologist, also known as Dr. Pimple Popper has squeezed, pinched, punctured to the delight of over one hundred million viewers on YouTube.

The patient was in his mid-30s and came in at his wife’s insistence on a Friday night. Earlier in the day, he’d noticed a small lump under his tongue. He’d planned to stop into a walk-in clinic later that weekend, but his family couldn’t take the stench. The nurse at triage took his pulse, and blood pressure, but just as soon as he’d opened his mouth and raised his tongue, she said “that’s good,” waved him off, and took breaths through her mouth.

“I’ve had problems with the right side of my mouth for years,” he said.

“How many years?”

“Over twenty. It swells under my tongue on this side,” he said, thumb planted into his lower jaw. “It comes, then it goes.”

“What brought you in today?”

“It began to swell, and then I felt a lump under my tongue. Right in the middle.”

I asked him to raise his tongue. A tiny whitehead was on the floor of his mouth, right in the middle. “It looks like it’s infected,” I told him. “I just need to make a small incision.” Seconds later, I poked it with the tip of a scalpel, expecting a surge of pus to relieve the pressure. It was rock hard. When I tapped it a second time, the patient winced as the flesh under his tongue bulged. “It’s not an abscess,” I told the patient, as the odor hit me. It didn’t smell like pus — it smelled worse. It was the putrid pungency of blue cheese, only without the cheese, just the blue.

I returned with forceps, two masks around my lips and nose, and a cinematographer named Pez. I grabbed the tip of the whitehead and pulled it. It slid out smoothly and looked like a small saber-tooth.

It was a sialolith — a salivary duct stone.

The estimated frequency of sialoliths in the general adult population is 1.2 percent. As with this patient, most occur in the submandibular gland, or its duct — Wharton’s duct — and can be seen on X-ray if symptomatic. Most stones are smaller than 10 mm, and they are rarely larger than 15 mm. In fact, those larger than 15mm can be classified as ‘Giant’ Salivary gland calculi, and only 14 well-documented cases of giant stones were reported in medical literature between 1942 and 2002.

Although there were no signs of infection after removal, it was likely that the stone itself was harboring bacteria that had clumped onto it and, considering the horrendous stench, festered.

And the patient? He was relieved to have finally the (giant) 23mm stone removed. And six months later, the patient reported no residual symptoms.

Raj Waghmare is an emergency physician who blogs at the ERTales.com.

Image credit: Shutterstock.com

Prev

Treating addiction: Rewriting patients' country songs

June 1, 2017 Kevin 1
…
Next

A retired physician asks: Am I still a doctor?

June 1, 2017 Kevin 15
…

Tagged as: Emergency Medicine

Post navigation

< Previous Post
Treating addiction: Rewriting patients' country songs
Next Post >
A retired physician asks: Am I still a doctor?

More by Raj Waghmare, MD

  • On the front lines of a COVID-19 assessment clinic

    Raj Waghmare, MD
  • Too many scans is bad medicine

    Raj Waghmare, MD
  • The art of diagnosis is like a riddle

    Raj Waghmare, MD

Related Posts

  • Denying payment for emergency care: a physician defends insurers

    Michael Kirsch, MD
  • A prayer from an emergency physician

    Edwin Leap, MD
  • The climate crisis as viewed by an emergency physician

    Elizabeth M. Barreras-Rivest, MD
  • A physician’s addiction to social media

    Amanda Xi, MD
  • How working as a flight attendant made me a better physician

    Alexie Puran, MD
  • How a physician keynote can highlight your conference

    Kevin Pho, MD

More in Conditions

  • Why patients write: stress relief, self-care, and sharing experiences

    R. Lynn Barnett
  • Misinformed claims and the offensiveness of discrediting COVID-19 vaccine development

    Angel Garcia Otano, MD
  • Family support is pivotal in the treatment of schizophrenia

    Frank Chen, MD
  • Exploring disfigurement and self-worth

    Kathleen Watt
  • Are we doing enough to help chronic pain sufferers?

    Adam Strohl, MD
  • Lessons taught by Bell’s palsy

    Alexander Rakowsky, MD
  • Most Popular

  • Past Week

    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Motorcycle helmet laws: Balancing freedom and financial impact

      Stephen Cohn, MD | Conditions
    • Balancing efficiency and compassion [PODCAST]

      The Podcast by KevinMD | Podcast
    • The link between orofacial myofunctional disorders and dental health

      Stephanie Jeret | Conditions
    • How compassionate leadership saved this physician [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Navigating the broken medical system: challenges faced by foreign medical graduates

      Anonymous | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • The essence of medicine: genuine connections in practice

      Jennifer Tillman, MD | Physician
  • Recent Posts

    • Balancing efficiency and compassion [PODCAST]

      The Podcast by KevinMD | Podcast
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Why patients write: stress relief, self-care, and sharing experiences

      R. Lynn Barnett | Conditions
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • Misinformed claims and the offensiveness of discrediting COVID-19 vaccine development

      Angel Garcia Otano, MD | Conditions
    • Bitcoin’s role in diversified portfolios [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Did Gabapentin Improve Post-COVID Olfaction?
  • Fentanyl Death Trends; Food Additives and Heart Disease
  • What If the Doctor Is Out?
  • Reduced Mortality Seen in Cancer Survivors Who Meet Exercise Guidelines
  • CDC Advisors Endorse Maternal RSV Vax to Protect Newborns

Meeting Coverage

  • Loneliness Needs to Be Treated Like Any Other Health Condition, Researcher Suggests
  • Stopping Medical Misinformation Requires Early Detection
  • AI Has an Image Problem in Healthcare, Expert Says
  • Want Better Health Outcomes? Check Out What Other Countries Do
  • ERS Roundup: Cell Transplant Boosts Lung Function in COPD Patients
  • Most Popular

  • Past Week

    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Motorcycle helmet laws: Balancing freedom and financial impact

      Stephen Cohn, MD | Conditions
    • Balancing efficiency and compassion [PODCAST]

      The Podcast by KevinMD | Podcast
    • The link between orofacial myofunctional disorders and dental health

      Stephanie Jeret | Conditions
    • How compassionate leadership saved this physician [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Navigating the broken medical system: challenges faced by foreign medical graduates

      Anonymous | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • The essence of medicine: genuine connections in practice

      Jennifer Tillman, MD | Physician
  • Recent Posts

    • Balancing efficiency and compassion [PODCAST]

      The Podcast by KevinMD | Podcast
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Why patients write: stress relief, self-care, and sharing experiences

      R. Lynn Barnett | Conditions
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • Misinformed claims and the offensiveness of discrediting COVID-19 vaccine development

      Angel Garcia Otano, MD | Conditions
    • Bitcoin’s role in diversified portfolios [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The abscess that surprised this emergency physician
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...