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AP (A) and lateral radiographs (B) of the knee demonstrate joint space narrowing and suprapatellar joint effusion.
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AP and lateral views of the knee showed no fractures or evidence of arthritis, but a small suprapatellar effusion was present (Fig. 1).
PMC4921185_02
(A) AP and (B) Lateral radiograph of the knee demonstrates increased osteopenia, joint effusion, and erosion of the medial trochlear surface (arrow).
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AP and lateral views of the knee, when compared to earlier radiographs, showed decreased bone density and a large erosion of the medial trochlear facet, with a small effusion of the suprapatellar bursa (Fig. 2).
Sagittal (A) T1, (B) fat-saturated proton density, and (C) fat-saturated T1 postcontrast images demonstrate a large, well-defined erosion (black arrow in A), patchy bone marrow edema (long white arrow in B), and synovial thickening and enhancement (white arrow in C).
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MRI revealed a 3-cm, sharply demarcated erosion of the anterior aspect of the trochlear notch and medial facet, with synovial thickening and enhancement and patchy edema of the femoral and tibial metaphyses (Fig. 3).
PMC4921185_03
A. H&E stain. Characteristic spherules of coccidioides from knee debridement. Various sizes and stages of spherules are typical. Fig 4B. H&E stain. Granuloma formation with histiocytes and giant cells in a background of chronic lymphocytic inflammation. Granuloma surrounds a coccidioidal spherule filled with endospores that could disseminate if ruptured. Fig 4c. GMS stain. Coccidioidal spherules within granulomas display variable uptake of silver stain.
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Findings were described as most consistent with a subspecies of Coccidioides being the causal organism (Fig. 4).
PMC4921185_04
AP radiograph of the chest demonstrates a wedge-shaped area of air space consolidation in the right upper lobe containing a crescentic lucency (arrow). There is mild retraction of the right hilum likely related to volume loss and scarring.
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Radiographs demonstrated opacity in the medial right lung apex, with a central curviliniar lucency (Fig. 5).
(A) Axial CT of the chest demonstrate a 3-cm cavitary lesion in the right upper lobe containing soft-tissue density with a crescentic lucency in the nondependent portion. (B) Coronal reformatted CT image demonstrates right-upper-lobe bronchiectasis, scarring, and multiple centrilobular nodules.
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There was adjacent bronchiectasis, parenchymal scarring, and multiple, small centrilobular nodules in the right upper lobe (Fig. 6).
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