Necrotizing fasciitis (NF) is a critical and rapidly progressive infection of the skin and soft tissue, and it is associated with a high mortality rate. NF of the cervicofacial region is uncommon due to the rich vascular supply of the head and neck, which promotes an efficient immune response to infection. Patients who are immunocompromised or have comorbidities affecting the vasculature, such as diabetes mellitus or peripheral vascular disease, are at an increased risk of more severe disease and outcome. Cervicofacial necrotizing fasciitis (CNF) is most frequently attributed to mucosal damage, such as those related to dental infections or local trauma including medical procedures. Due to its ability to quickly spread to the neck and mediastinum, CNF must be diagnosed and treated expeditiously. In this report, we present a case of a 28-year-old female with a past medical history significant for obesity and tobacco abuse who presented to the emergency department (ED) with fever, left-sided facial pain, cervical pain, and swelling. She had worsening symptoms despite current treatment with clindamycin for a dental abscess. A CT scan of the head and neck revealed an odontogenic abscess complicated by CNF. Intravenous antibiotics were initiated and she underwent prompt surgical intervention. She remained nasally intubated following her surgery due to concern for postoperative edema leading to airway compromise. Following extubation, she experienced an uncomplicated recovery. This case demonstrates that NF is a complication of dental infection that may occur even in young and relatively healthy patients. Additionally, due to the swiftly destructive nature and high mortality rate of CNF, early diagnosis and aggressive medical and surgical therapy are essential to reduce morbidity and mortality.

Objectives:To explore the potential of 3-dimensional trans-vaginal elastography in the evaluation of fibroids. Methods: 10 women with known fibroids attending for trans-vaginal ultrasound were recruited to have 3-dimensional trans-vaginal ultrasound elastography. Stradwin software (http://mi.eng.cam.ac. uk/∼rwp/stradwin/) running on an Ultrasonix Sonix RP was used to acquire the RF data and calculate strain images in real time. This software uses a colour wash to mask areas where the strain data is unreliable due to signal decorrelation. Information about the participant's age, uterine position, B-mode ultrasound result, and other imaging were recorded. The elastograms were analysed with reference to the B-mode image for whether (a) the fibroid could be identified in 3 orthogonal planes (b) the endometrium identified on the elastogram. Results: The average age of the 10 women was 52.4 years and the average uterus size of 72.4 mm (range 60-102 mm). 50% of women had anteverted uteri and 50% retroverted uteri. In all 10 patients good quality elastogram images (with minimal colour wash) were obtained. In 100% of cases the largest fibroid in each uterus could be demonstrated in 3 orthogonal planes on the elastogram. In 60% of participants the endometrium could be identified on the elastogram as a linear area of softness. In one patient a suspected sub-mucosal fibroid seen on the elastogram but not conventional ultrasound was confirmed by subsequent hysteroscopy. Conclusions:Fibroids can be demonstrated with 3-dimensional elastography and their position shown in orthogonal planes. This may help to differentiate sub-mucosal and intra-mural fibroids when conventional ultrasound is inconclusive. P33.02Interobserver agreement on reporting breast density using extended view ultrasound imaging (XTD-view)Fetal Medicine, GEMINA, Londrina, Brazil Objectives: To evaluate the level of interobserver agreement on reporting breast density using extended view ultrasound imaging (XTD-view). Methods: A single examiner performed 100 consecutive breast. Ultrasounds, including the extended view (XTD-view) scan, with a 10.0-14.0 MHz linear transducer (GE-Voluson E8). Images of bilateral breast external superior quadrant and lesions, when detected, where recorded. Three interobservers were asked to report the breast density (homogeneous fibroglandular, homogeneous adipose or heterogeneous), based on 2D and extended view ultrasound imaging (XTD-view). Mammography, when carried out, was consulted. Results: Statistical analysis in process. Conclusions: The ability on reporting breast density and other findings based on extended view ultrasound imaging (XTD-view), still in process of conclusion.Supporting information can be found in the online version of this abstract. Patients have been allocated into two groups based on histological diagnosis. Group A: Ca endometrium (n = 31, 7 pre and 24 post) and group B: Ca ovaries (n = 40, 13 pre and 27 post). Ultrasound data were compared to CT results and histological reports. Results: In group A we ob...

INTRODUCTION: Pyogenic ventriculitis (PV) is a severe intracranial infection characterized by the presence of suppurative fluid within the ventricles. Common sources include trauma, meningitis, or ruptured brain abscesses. Here, we present a case of PV disseminating from infective endocarditis (IE), a phenomenon reported only three other times in medical literature [1].

Enterovirus-human-rhinovirus (EV-HRV) is best known to cause the "common cold" and asthma exacerbations. Simple bronchitis and community-acquired pneumonia related to EV-HRV are also well documented. Scattered reports of rhinovirus causing acute respiratory distress syndrome (ARDS) have been published, yet the causality between recent SARS-CoV-2 pneumonia and severe ARDS secondary to EV-HRV has not been well defined. This case presents a 67-year-old male who was unvaccinated against SARS-CoV-2 with a past medical history of chronic obstructive pulmonary disease, who recently experienced a mild-tomoderate case of SARS-CoV-2 pneumonia, which was treated with dexamethasone and remdesivir. He was discharged to an inpatient psychiatric facility on as-needed oxygen via nasal cannula. Three weeks later, he experienced an episode of presyncope and was readmitted to the hospital. He then began to require increasing levels of supplemental oxygen via a high-flow nasal cannula. A real-time polymerase chain reaction respiratory pathogen panel was positive for EV-HRV. Computed tomography of the chest revealed extensive ground-glass opacities. Further workup for bacterial and fungal pneumonia was negative. Repeat SARS-CoV-2 testing was also negative. He required several days of supplemental oxygen via a high-flow nasal cannula. He received a short course of broad-spectrum antibiotics and a 10-day course of high-dose dexamethasone. Ultimately, he fully recovered, did not require further supplemental oxygen, and was discharged on room air.

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