PMC6180849_01
Ultrasonography of the supraclavicular region. (a) Subcutaneous hyperechoic, complex fluid collection extending above the right clavicle and between the clavicle fragments, with the presence of hyperechoic gas bubbles (white arrows). (b) A free fragment of the clavicle cortical bone (white arrow) surrounded with thick, hyperechoic fluid collection (black arrow).
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fig1
An emergency ultrasound examination of the upper arm showed a collection of thick fluid with the presence of gas bubbles and a free fragment of the cortical bone (Figure 1).
X-ray image of the right shoulder. A wide, lucent fracture line without dislocation between the fragments is seen at the distal third of the right clavicle (black arrow). The X-ray was taken during the patient's first visit to the emergency department and was misinterpreted as normal.
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fig2
At this point, the shoulder X-ray image that was taken during the patient's first visit to the hospital was re-examined, and a clavicle fracture in the distal third of the clavicle was diagnosed (Figure 2).
MRI of the right shoulder. (a) T
2 fast relaxation fast spin-echo fat-saturated sequence, axial images. Continuation of a large abscess distally encompassing the anterior compartment of the right arm. The fluid collection extended almost to the level of the elbow (white arrows). An additional finding was the moderate right pleural effusion (grey arrow). (b) T
1 fast spin-echo fat-saturated post-contrast images in the coronal plane. Clavicle fracture and destruction with a markedly diffuse, inflammatory post-contrast enhancement of the clavicle (black arrows). Peripheral ring enhancement of the supraclavicular and brachial abscess formation is evident (white arrows).
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The imaging protocol was performed using a short tau inversion-recovery sequence (coronal plane), a T 2 fast relaxation fast spin-echo (FSE) fat-saturated sequence (axial plane) and a T 1 FSE sequence (coronal plane) before i.v. application of the paramagnetic contrast media, and afterwards with a T 1 FSE fat-saturated sequence (coronal, axial plane). The MRI confirmed osteomyelitis of the clavicle and moderate right-sided pleural effusion (Figure 3a,b).