PMC8046485_01
Image showing a clinical picture of the right shoulder with massive swelling demonstrating fluctuation. Clinical image of the right shoulder showing a massive dumbbell-shaped swelling, soft in consistency with positive fluctuation.
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F1
Reveals massive dumbbell-shaped swelling over the right shoulder which is soft in consistency with ill-defined margins showing cross-fluctuation (Fig. 1-3).
Image showing lateral aspect of the right shoulder with dumbbell-shaped swelling. Clinical image of the right shoulder showing lateral aspect of dumbbell-shaped swelling.
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PMC8046485_01_JOCR-11-23-g002.jpg
F2
Reveals massive dumbbell-shaped swelling over the right shoulder which is soft in consistency with ill-defined margins showing cross-fluctuation (Fig. 1-3).
Image showing posterior aspect of the right arm. Clinical image of the right shoulder showing posterior aspect of dumbbell-shaped swelling.
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PMC8046485_01_JOCR-11-23-g003.jpg
F3
Reveals massive dumbbell-shaped swelling over the right shoulder which is soft in consistency with ill-defined margins showing cross-fluctuation (Fig. 1-3).
Anteroposterior radiograph of the right shoulder at the time of presentation. Plain radiograph of the right shoulder anteroposterior view shows erosion of the glenoid cavity and head of the humerus with a reduction in the joint space. Obliteration of adjacent fat planes is seen with minimal erosion of lateral end of clavicle.
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F4
X-ray right shoulder anteroposterior view (Fig. 4) shows erosion of the glenoid cavity and head of the humerus with a reduction in the joint space.
Chest radiograph showing miliary changes in both the lung fields. Plain posteroanterior radiograph of chest showing widespread small nodular opacities distributed throughout the lung fields suggestive of miliary tuberculosis (past history).
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F5
Magnetic resonance imaging T2-weighted coronal section. Magnetic resonance imaging of the right shoulder T2-weighted coronal cut showing cortical erosions involving articular margins of humeral head and bony glenoid. There are moderate joint effusion and synovial thickening with a large loculated periarticular collection extending to supraspinatus fossa and upper arm along with the deltoid muscle.
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F6
Magnetic resonance imaging right shoulder joint (Fig. 6, 7) shows cortical erosions involving articular margins of the humeral head and bony glenoid.
Magnetic resonance imaging T2-weighted axial section of the right humerus. Magnetic resonance imaging of the right shoulder T2-weighted axial cut showing a large bilocular collection around right humerus with soft-tissue edema.
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F7
Magnetic resonance imaging right shoulder joint (Fig. 6, 7) shows cortical erosions involving articular margins of the humeral head and bony glenoid.
Final clinical picture of the right shoulder after three sessions of aspiration and injection and 1 year of anti-tubercular therapy. Clinical picture of the right shoulder and arm at 1-year follow-up after complete ATT and three sessions of aspiration and injection streptomycin.
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F8
At 1-year follow-up, although the movements were restricted (flexion 50 , extension 20 , abduction 60 , adduction 0 , internal rotation 10 , and external rotation 10 ) and mostly scapulothoracic, the patient had gained weight, had no pain or swelling, and could carry out his day-to-day activities without much discomfort (Fig. 8).
Plain radiograph of the right shoulder at 1-year follow-up shows healing with sclerosis at proximal humerus and superior migration of humeral head. There were no changes in the glenoid cavity with a resolution of previous osteolytic lesions rendering the glenohumeral joint in incongruous congruity.
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F9
The anteroposterior radiograph (Fig. 9) showed healing with sclerosis at proximal humerus and superior migration of head of the humerus.