Winging of the scapula and induration of the trapezius muscle are clinical clues for which chest wall infection?

Winging of the scapula and induration of the trapezius muscle are clinical clues for which chest wall infection?

• A. Subscapular Abscess
• B. Pectoral Abscess
• C. Pleural Empyema
• D. Intercostal Hernia

Answer: (A)

Winging of the scapula with induration of the trapezius points to a posterior chest wall process involving the subscapular space. A subscapular abscess sits deep to the scapula and inflames the surrounding posterior muscles and nerves that stabilize the shoulder girdle. This can manifest as palpable induration of the trapezius and weakness of scapular stabilizers such as the serratus anterior, leading to scapular winging. The other infections are not in the posterior chest wall region and do not produce this combination of posterior muscular signs: a pectoral abscess is in the anterior chest wall; pleural empyema is a pleural space infection with chest pain, fever, and effusion rather than posterior muscle findings; an intercostal hernia presents as a chest wall defect with bulging rather than targeted posterior muscle induration and winging.

Winging of the scapula with induration of the trapezius points to a posterior chest wall process involving the subscapular space. A subscapular abscess sits deep to the scapula and inflames the surrounding posterior muscles and nerves that stabilize the shoulder girdle. This can manifest as palpable induration of the trapezius and weakness of scapular stabilizers such as the serratus anterior, leading to scapular winging. The other infections are not in the posterior chest wall region and do not produce this combination of posterior muscular signs: a pectoral abscess is in the anterior chest wall; pleural empyema is a pleural space infection with chest pain, fever, and effusion rather than posterior muscle findings; an intercostal hernia presents as a chest wall defect with bulging rather than targeted posterior muscle induration and winging.