Presentation
Recently diagnosed diabetic. Swollen left sternoclavicular joint.
Patient Data
Small left sternoclavicular joint effusion from which anteriorly arises a 2.3 cm collection.
Bone marrow edema in the adjacent manubrium and proximal sternum.
Extensive soft tissue edema and inflammatory change in the superficial soft tissues of the left anterior chest wall and mediastinal fat.
Extensive edema in the soft tissues overlying the left sternoclavicular joint.
2.4 cm effusion in the sternoclavicular joint.
The patient was exquisitely painful to probe palpation.
The joint effusion was aspirated under ultrasound guidance. 4 mls of frank pus was aspirated and sent for microbiological analysis.
Culture Report - aspirate from left sternoclavicular joint
1) Heavy growth of Staphylococcus aureus
Clindamycin R Erythromycin R Flucloxacillin S
Culture Comment
Septic arthritis requires minimum 4 weeks of antibiotics. Discuss if not improving on IV Flucloxacillin 2g QDS.
TISSUE/BONE MC&S
Gram Stain:
Pus Cells +++
Organisms Gram positive cocci ++
Case Discussion
This patient's first presentation with diabetes mellitus arose following this diagnosis of Staphylococcus aureus septic arthritis of the sternoclavicular joint.
On a practical note the curvilinear probe can be of great utility even when assessing superficial structures when there is marked superficial soft tissue edema. It can facilitate easier guided aspiration if the parameters such as zoom and gain are set to improve easy observation.