Presentation
Fever followed by right distal leg pain for the last 2 days. Difficulty in walking. No trauma.
Patient Data
The distal anterior tibia shows subperiosteal fluid with internal echoes. There is no erosion of the underlying tibial cortex. Anechoic effusion is present in the anterior ankle recess along with anechoic subperiosteal fluid rim in the distal fibula. Pulsations of the patent anterior tibial artery result in mobile echoes in the subperiosteal fluid. Local subcutaneous fat is echogenic without any collection.
There is subperiosteal pus in the distal anterior tibia. About 10 to 15 cc of pus was drained followed by wound irrigation and tibial cortical surgical drilling.
Case Discussion
A girl presented with fever and right anterior distal leg region pain for the last two days. The ultrasound revealed distal tibial subperiosteal fluid with mobile echoes which favor abscess. Later an MRI (not uploaded, no copyright) detected distal tibial subperiosteal fluid with marrow changes. Surgery confirmed tibial subperiosteal pus.
Intraoperative details and photos courtesy: operating surgeon Dr. Piyush Patel.
Pus culture and sensitivity revealed methicillin-resistant Staphylococcus aureus.
Pus culture and sensitivity report courtesy: pathologist Dr. Bharat Tandel