Acute osteomyelitis - humerus

Case contributed by Dr Maulik S Patel

Presentation

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

Patient Data

Age: 10 years
Gender: Male
X-ray

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

Ultrasound

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.

Ultrasound

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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Case information

rID: 22138
Published: 14th Mar 2013
Last edited: 2nd Jan 2021
Inclusion in quiz mode: Included

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