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Front (A) and side (B) photographs showing a large mass in the anterior region of the proximal third of the right arm.
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HUCFF, reporting worsening of symptoms and an increase of tumor volume in the anterior region of the arm associated with the appearance of localized heat and erythema (Figure 1). He was febrile (38.8 C) and had completed the 2nd month of RHZ.
Imaging tests. (A) Anteroposterior plain radiograph of the shoulder and proximal half of the left humerus, showing only an increase in the volume of soft tissue. (B) Coronal oblique slice magnetic resonance image of the shoulder and upper half of the right arm, T2-weighted fat-suppressed, revealing voluminous collection in the proximal region of the arm, following the long portion of the biceps proximally. (C) T1-weighted axial slice magnetic resonance image of the proximal region of the right arm showing large collection in its anterior region.
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In contrast, magnetic resonance imaging revealed the presence of predominantly hypointense lesions on T1 and hyperintense in the other sequences, localized in the meta-epiphyseal region of the humerus and glenoid, in addition to large joint effusion and synovial thickening; it also showed voluminous anterior collection in the proximal third of the arm, in close relation with the biceps tendon (Figure 2).
Photograph showing the performance of fine needle aspiration of the mass, which revealed heterogeneous, thick, and yellowish liquid content. The smear of the liquid using Ziehl-Neelsen staining confirmed the presence of acid-fast bacilli (AFB).
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The collection involving the biceps tendons was punctured percutaneously, immediately before the surgical procedure, under surgical antisepsis with iodine alcohol solution (Figure 3).
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Photograph obtained during surgery, after draining the collection showing infectious material on the coracobrachialis and biceps muscles, with moderate tissue damage. The patient underwent rigorous debridement and thorough washing of the wound.
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(Figure 4) after opening the bicipital sheath.
(A, B and C): Photographs of the patient showing good final clinical results after 24 months of outpatient treatment.
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At the moment, with 24 months of follow-up, he complains of mild discomfort in the right shoulder only upon great exertion and its function is graded as good (33 points) according to the UCLA scale (Figure 5).