PMC10312336_01
Imaging of Candida septic arthritis in the left shoulder. (A and B): Anteroposterior (A) and Supraspinatus export (B) radiographs of the left shoulder show bone erosions at the acromion, glenoid and humeral head. (C): T1-weighted image showing no obvious "rice body"-like structures in the enlarged bursa. (D-F): CT scans showed clearer bone destruction at the acromion, glenoid and humeral head. (G-I): T2-weighted image shows hundreds of rice bodies in the subacromial-subdeltoid bursa, subcoracoid bursa and a large rotator cuff tear. (J-L): MRI T1 after gadolinium enhancement shows that the synovial membrane was obviously enhanced, but the rice body formations were not.
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Plain radiography (Figure 1A and B) and CT scan (Figure 1D-F) showed bone erosion at the humeral head, the subchondral portion of the glenoid and the acromion. T2 signal shadows filling (Figure 1G-I). The enhanced gadopentetate with meglumine scan showed obvious enhancement of the synovium in the T1 sequence, but no enhancement was found in the rice body formation inside the bursa (Figure 1J-L). 
Macroscopic view and histopathology of rice body formation and postoperative images. (A): Rice bodies and yellow bursa fluid were removed after the channel was placed. (B) Yellow bursa fluid and rice bodies of various sizes (approximately a few millimeters). (C and D): Arthroscopic observation of rice bodies of different sizes and smooth surfaces. (E and F): Histopathology suggests that the rice body is mainly composed of fibrin material with inflammatory cells. (G and H): Postoperative MRI showed complete removal of rice bodies.
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The observation channel was placed through the posterior approach, and a lot of rice bodies in yellow bursa fluid were observed to flow out (Figure 2A and B). After the lens was placed, rice bodies with a diameter of approximately 1-5 mm filled the joint cavity (Figure 2C and D). Postoperative MRI showed that although the swelling around the joint was obvious, there was no remaining rice body (Figure 2G and H).  The histopathological examination of the rice body showed that it was mainly composed of fibrin without a clear tissue structure, with some small amount of tissue and cell coagulation (Figure 2E and F).
Disease record during recurrence. (A and B): T2-weighted image shows a lot of fluid accumulation in the subacromial-subdeltoid region with necrotic synovial tissue floating. (C and D): Ultrasound examination showed some synovium looked like 'floating weeds'. (E) Apparent joint swelling of the patient. (F): The necrotic synovium floating in the joint cavity and not completely detached under arthroscopy.
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However, the shoulder swelled again after two weeks of oral administration (Figure 3E). MRI revealed a lot of fluid accumulation in the subacromial-subdeltoid region with necrotic synovial tissue floating (Figure 3A and B). Ultrasound examination showed joint cavity effusion, synovial hyperplasia, and some synovium looked like "floating weeds" (Figure 3C and D). Under arthroscopy, there is no obvious rice body formation in the joint cavity, but a large amount of necrotic synovial tissue floating as seen in ultrasound (Figure 3F).