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Photograph of the patient when he initially presented.
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Local examination revealed a 5 cm fluctuant swelling over the A-C joint with surrounding erythema, with 2 discharging punctum and local rise of temperature(Fig. 1)The A-C joint was tender and shoulder movements were restricted.
A plain radiograph of the shoulder showed joint space widening with acromioclavicular joint osteoarthritis.
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A plain radiograph of the shoulder AP and axial view (Fig. 2 & Fig. 3)showed joint space widening with acromioclavicular joint osteoarthritis.
Ultrasonography showed 32 mm fluid collection over the left Acromioclavicular joint, with increased vascularity.
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Ultrasonography showed 32 mm fluid collection over the left Acromioclavicular joint, with increased vascularity(Fig. 4).
Photograph of the patient after two weeks.
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At two week follow up even though the incision sites were healing well(Fig. 5 & Fig. 6) patient was having persistent raised inflammatory markers.
Precontrast and post contrast MRI images of patient performed at 2 weeks.
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A follow up MRI scan after two weeks with contrast revealed 52x45x32 mm focal collection within the superficial soft tissues towards the posteromedial aspect of the left Acromioclavicular joint, communicating with the left AC joint(Fig. 7 &Fig. 8).
Precontrast and post contrast MRI images of patient performed at 2 weeks.
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Overall features suggested of Left acromioclavicular joint septic arthritis(Fig. 9 & Fig. 10).