Acute osteomyelitis - humerus

Case contributed by Dr Maulik S Patel


Right proximal arm and shoulder pain for the last two days.

Patient Data

Age: 10 years
Gender: Male

There is no periosteal reaction/ bone lesion/ fracture/ dislocation. There is soft tissue swelling involving the shoulder and the proximal arm region.


There is subperiosteal fluid in the proximal humeral metaphysis region. There is no obvious cortical erosion. There is no effusion in the biceps tendon sheath. Rotator cuff was normal.

2nd ultrasound study 36 hours later.


There is an additional finding of a non-compressible axillary vein with internal echoes. There was no color flow in the vein. The acompanying artery is patent.

Case Discussion

A child had the right shoulder and the proximal arm region swelling and pain. X-ray was negative for a periosteal reaction. Ultrasound showed subperiosteal fluid involving the proximal humerus. Follow up ultrasound revealed an additional finding of axillary venous thrombosis. Surgery confirmed the presence of subperiosteal pus. A pathology study showed staphylococcus aureus.

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