PMC6900941_01
X-ray and fluoroscopic views of the right shoulder. (a) Anterior-posterior view. (b) Axial view. (c) Zanca view. (d) Acromioclavicular small-needle aspiration under fluoroscopic guidance.
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Anterior-posterior, axial, and Zanca view x-rays showed an osteolysis of the distal clavicle (Figure 1). We performed blood cultures and a small-needle aspiration of the ACJ, using fluoroscopic guidance (Figure 1).
Arthroscopic views of the right shoulder. We can notice the absence of inflammatory aspect of the tissues. (a) Subacromial space. (b) Glenohumeral space with the long head of the biceps brachii.
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Then, the patient was informed for consent of a shoulder arthroscopy with biopsies of the glenohumeral joint and subacromial space (Figure 2), followed by an open surgical washout with capsule and clavicle biopsies and partial distal clavicular resection. Intraoperative arthroscopic findings showed no inflammation of the glenohumeral joint and subacromial space (Figure 2).
Histologic findings. (a) A capsule biopsy, with massive acute inflammation compatible with an infection. (b) A distal clavicle bone sample, with signs of chronic inflammation associated with mild acute inflammation. There was no malignancy.
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Additionally, the biopsy confirmed the presence of an acute inflammation compatible to a local infection (Figure 3).