PMC8634897_01
Clinical photograph of swelling over left shoulder.
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F1
In March 2021, she had a trivial fall over the same shoulder, and since then, she noticed an increasing swelling around the same shoulder, which grew from the size of a lemon to a half-cut watermelon spanning in between her neck and affected shoulder (Figure 1).
X-ray of the affected shoulder showing destruction of AC joint and metal anchor in-situ.
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F2
An X-ray revealed bony destruction at the lateral end of the clavicle with the metal anchor in situ in the shoulder (Figure 2).
T2 weighted coronal MRI image of the shoulder showing the subcutaneous sac communicating to AC and Shoulder Joint.
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F3
Moderate glenohumeral joint effusion extending into the subacromial and subdeltoid spaces were also reported suggestive of corresponding bursitis (Figure 3).
Surgical incision.
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F4
The patient underwent swelling excision in toto and debridement of the left acromioclavicular and shoulder joint (Figures 4, 5, and 7).
Sac with its communication to AC joint shown.
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F5
The patient underwent swelling excision in toto and debridement of the left acromioclavicular and shoulder joint (Figures 4, 5, and 7).
Straw yellow coloured pus drained out.
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F6
AC joint to the subacromial and subdeltoid bursae up to the humeral head entry site for the metal anchor. Around 500 mL of straw yellow pus was drained out of the excised sac and from the shoulder joint (Figure 6).
Sac excised in toto with superficial skin.
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F7
The patient underwent swelling excision in toto and debridement of the left acromioclavicular and shoulder joint (Figures 4, 5, and 7).
Osteomyelitic nidus retrieved from the humeral head through the debridement hole.
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F8
The deep-seated metal anchor in the humeral head was surrounded by a nidus of osteomyelitis sequestrum, which was debrided and retrieved along with the metal and bio absorbable anchors (Figure 8).
Hand E-stained slide [x100 magnification] showing multinucleated giant cells and granulation tissue.
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F9
HPE was consistent with chronic granulomatous infection (Figures 9 and 10).
Hand E-stained slide [x400 magnification] showing epithelioid cell forming granuloma.
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F10
HPE was consistent with chronic granulomatous infection (Figures 9 and 10).