Musculoskeletal Infections: US Manifestations1
Nathalie J. Bureau, MD, FRCPC,
Rethy K. Chhem, MD, PhD, FRCPC and
Étienne Cardinal, MD, FRCPC
1 From the Department of Radiology, Hôpital Saint-Luc, Centre Hospitalier de l'Université de Montréal, 1058 rue Saint-Denis, Montreal, Quebec, Canada H2X 3J4 (N.J.B., E.C.); and the Department of Diagnostic Radiology, National University Hospital of Singapore (R.K.C.). Presented as a scientific exhibit at the 1998 RSNA scientific assembly. Received February 8, 1999; revision requested March 19; final revision received June 17; accepted June 21. Address reprint requests to N.J.B.
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Figure 1. Cellulitis of the right leg in an 80-year-old woman. Extended-field-of-view longitudinal US scan shows diffuse thickening of subcutaneous tissues with a predominantly echogenic texture (arrows) and hypoechoic strands (arrowhead). The presence of an abscess was excluded with US.
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Figure 2. Septic bursitis of the olecranon bursa. Extended-field-of-view longitudinal US scan of the posterior elbow shows a heterogeneous, hypoechoic fluid collection (arrows) adjacent to the olecranon (O) and triceps tendon (T). S aureus was cultured from fluid obtained with US-guided aspiration.
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Figure 3a. Acute bacterial tenosynovitis. C = capitate, L = lunate, M = third metacarpal, R = radius. (a) Longitudinal US scan at the level of the capitate-lunate joint shows a small effusion in the extensor tendon sheath (arrow). US-guided aspiration yielded 0.5 mL of fluid. (b) Longitudinal US scan shows injection of 2 mL of normal saline solution (arrow) for lavage, of which 1.5 mL was aspirated and sent for culture. S aureus was cultured from the aspirate.
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Figure 3b. Acute bacterial tenosynovitis. C = capitate, L = lunate, M = third metacarpal, R = radius. (a) Longitudinal US scan at the level of the capitate-lunate joint shows a small effusion in the extensor tendon sheath (arrow). US-guided aspiration yielded 0.5 mL of fluid. (b) Longitudinal US scan shows injection of 2 mL of normal saline solution (arrow) for lavage, of which 1.5 mL was aspirated and sent for culture. S aureus was cultured from the aspirate.
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Figure 4a. Abscess of the right forearm in a 19-year-old intravenous drug abuser. (a) Longitudinal US scan shows a large subcutaneous fluid collection filled with echogenic material. (b) Longitudinal US scan shows fluid aspiration with a 16-gauge needle (arrow). The aspiration yielded 30 mL of purulent material and almost emptied the collection. (c) Longitudinal US scan obtained after repeat aspiration shows complete evacuation of the abscess. The patient was treated with intravenous antibiotics and did not require surgical drainage.
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Figure 4b. Abscess of the right forearm in a 19-year-old intravenous drug abuser. (a) Longitudinal US scan shows a large subcutaneous fluid collection filled with echogenic material. (b) Longitudinal US scan shows fluid aspiration with a 16-gauge needle (arrow). The aspiration yielded 30 mL of purulent material and almost emptied the collection. (c) Longitudinal US scan obtained after repeat aspiration shows complete evacuation of the abscess. The patient was treated with intravenous antibiotics and did not require surgical drainage.
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Figure 4c. Abscess of the right forearm in a 19-year-old intravenous drug abuser. (a) Longitudinal US scan shows a large subcutaneous fluid collection filled with echogenic material. (b) Longitudinal US scan shows fluid aspiration with a 16-gauge needle (arrow). The aspiration yielded 30 mL of purulent material and almost emptied the collection. (c) Longitudinal US scan obtained after repeat aspiration shows complete evacuation of the abscess. The patient was treated with intravenous antibiotics and did not require surgical drainage.
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Figure 5. Abscess of the right forearm in a 25-year-old intravenous drug abuser. Transverse color Doppler US scan shows diffuse hyperemia surrounding a multiloculated, hypoechoic fluid collection.
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Figure 6. Pyomyositis in a patient infected with human immunodeficiency virus. Longitudinal US scan shows a large, hypoechoic fluid collection (arrow) within the distal aspect of the gluteus medius muscle. S aureus was cultured from fluid obtained with US-guided aspiration.
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Figure 7a. Acute septic arthritis in a patient infected with human immunodeficiency virus. C = capitate, L = lunate, M = third metacarpal, R = radius, T = extensor tendon. (a) Midsagittal US scan of the wrist shows a fluid collection at the capitate-lunate joint (arrow). (b) Midsagittal US scan shows needle aspiration (arrows).
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Figure 7b. Acute septic arthritis in a patient infected with human immunodeficiency virus. C = capitate, L = lunate, M = third metacarpal, R = radius, T = extensor tendon. (a) Midsagittal US scan of the wrist shows a fluid collection at the capitate-lunate joint (arrow). (b) Midsagittal US scan shows needle aspiration (arrows).
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Figure 8. Osteomyelitis complicating a fracture of the distal tibia in a 35-year-old patient. Transverse US scan of the anterior aspect of the distal tibia shows a hypoechoic fluid collection with internal debris (arrow) adjacent to a cortical disruption (arrowheads). With compression, fluid was seen moving in and out of the bone. US-guided needle aspiration of the abscess yielded a diagnosis of S aureus infection.
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Figure 9. Acute osteomyelitis in a neonate. Longitudinal US scan shows a hypoechoic subperiosteal abscess (arrow) of the proximal clavicle (C) adjacent to the sternoclavicular joint. S = sternum.
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Figure 10a. Osteomyelitis complicating metallic fixation of the right femur in a 35-year-old man. (a) Extended-field-of-view longitudinal US scan of the lateral aspect of the femur shows a hypoechoic fluid collection (straight solid arrow) adjacent to a metallic plate (curved arrow) and the underlying cortex of the distal femoral diaphysis (arrowhead). Loosened screws are also identified (open arrows). (b) Radiograph obtained within 5 days of the US examination shows metallic fixation of a comminuted fracture of the distal femoral diaphysis. Lucent areas surrounding some of the screws (arrows) are suggestive of loosening. S aureus was cultured from fluid obtained with US-guided aspiration of the hypoechoic collection, and osteomyelitis of the femur with loosening of the metallic hardware was confirmed at surgery.
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Figure 10b. Osteomyelitis complicating metallic fixation of the right femur in a 35-year-old man. (a) Extended-field-of-view longitudinal US scan of the lateral aspect of the femur shows a hypoechoic fluid collection (straight solid arrow) adjacent to a metallic plate (curved arrow) and the underlying cortex of the distal femoral diaphysis (arrowhead). Loosened screws are also identified (open arrows). (b) Radiograph obtained within 5 days of the US examination shows metallic fixation of a comminuted fracture of the distal femoral diaphysis. Lucent areas surrounding some of the screws (arrows) are suggestive of loosening. S aureus was cultured from fluid obtained with US-guided aspiration of the hypoechoic collection, and osteomyelitis of the femur with loosening of the metallic hardware was confirmed at surgery.
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Copyright © 1999 by the Radiological Society of North America.
