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    • #16474
      Samuel Katumba

      Hi Steve
      Sorry for sub optimal images

      12 year old boy presented with swollen painful shoulder, fever + could not abduct arm.
      Enticed with obvious shoulder swelling, much of my effort was focused on shoulder-all I could see was fluid in gleno-humeral joint, in SASD bursa and between brachialis and humerus…I could not explain the findings.
      Curiously, I continued my adventure to wherever I could find an explanation, and I landed on echogenic and swollen muscle in postero-medial aspect of upper (think it was long head triceps)-with an echogenic turbid collection devoid of color signals? Abscess.
      What was I dealing with here? How do these findings fit together? What could be the differentials?
      Thank you

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    • #16476
      Samuel Katumba

      Plus more images/videos

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    • #16522
      Stephen Bird

      Hi Samuel,

      Nice images,

      Personally I think the shoulder joint and bursa are normal.

      I agree there is some fluid between the humerus and the distal biceps tendon but this fluid displaces the tendon anteriorly and I don’t think it is in the LHBT sheath / GH joint.

      The arm musculature is where the problem is here,

      It looks like a nasty infection involving the muscles of the upper arm.

      As this collection reaches the cortex of the bone an osteomyelitis needs to be a consideration,

      Whatever the cause, I think sepsis and abscess formation is the answer and I don’t think the shoulder GH joint is the source but rather humeral shaft or directly in the musculature.

      I imagine they will try and aspirate the abscess and culture it to find the infection source and plain radiographs of the shoulder / humerus will also be of benefit.

      Very interesting case mate.

      Let us know what follow up you can discover.


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