EURORAD ESR

Case 9145

Septic monoarthritis in a patient with gout

Author(s)
Jones TA, Filer A, Raza K
 
Patient
male, 51 year(s)
 
 
  • Figure 1
    Ultrasound examination of the left ankle
     

    Anterior longitudinal view. Synovitis (S) appears as a hypoechoic area, the effusion (E) appears as an anechoic area and vascularity is demonstrated by power Doppler positivity.

     
    Area of Interest: Musculoskeletal joint; Imaging Technique: Ultrasound; Ultrasound-Power Doppler; Procedure: Diagnostic procedure; Drainage; Special Focus: Arthritides; Inflammation;

    Anterolateral/axial view. Synovitis (S) appears as a hypoechoic area, the effusion (E) appears as an anechoic area and vascularity is demonstrated by power Doppler positivity.

     
    Area of Interest: Musculoskeletal joint; Imaging Technique: Ultrasound; Ultrasound-Power Doppler; Procedure: Diagnostic procedure;
     
     
  • Figure 2
    Aspirate from the tibiotalar joint

    1ml of purulent synovial fluid was drained under ultrasound guidance. Culture yielded Staphylococcus aureus. Polarised light microscopy revealed urate crystals.

     
    Area of Interest: Interventional non-vascular; Management; Musculoskeletal joint; Procedure: Diagnostic procedure; Drainage;
     
     
  • Figure 3
    Anteroposterior radiograph of the left ankle
     

    Joint space narrowing of the tibitalar joint with erosion of the articular surface of the distal fibula.

     
    Area of Interest: Bones; Emergency; Musculoskeletal joint; Imaging Technique: Conventional radiography;

    AP radiograph of the left ankle taken 3 months later showing progressive joint space reduction and increasing erosions/destruction.

     
    Area of Interest: Musculoskeletal joint; Imaging Technique: Plain radiographic studies; Special Focus: Arthritides;
     
     
  • Figure 4
    MRI left ankle

    Sagittal T2 sequence showing joint effusion and rapidly progressive periarticular joint destruction involving the talus, distal tibia and fibula with oedema of the subarticular bone marrow supports a diagnosis of a...

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal joint; Imaging Technique: MR; Special Focus: Arthritides;
     
     
  • Figure 5
    Technetium-99m dynamic isotope bone scan
     

    Venous phase. There is intense uptake in both venous and delayed images in the left ankle, predominantly in the distal end of the tibia. This is consistent with infection or severe inflammation.

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal joint; Imaging Technique: Nuclear medicine conventional; Special Focus: Arthritides;

    Intense uptake in the left ankle, and in particular the distal tibia on the delayed phase scan indicating infection, or any form of severe inflammation.

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal joint; Imaging Technique: Nuclear medicine conventional; Procedure: Diagnostic procedure; Special Focus: Arthritides;
     
     
  • Figure 6
    Tc99m-HMPAO white cell Fab leukoscan

    Increased uptake of tracer in the left ankle, predominantly in the distal tibia is suggestive of infection or severe inflammation/arthritis.

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal joint; Imaging Technique: Nuclear medicine conventional; Special Focus: Arthritides; Infection; Inflammation;
     
     
Anterior longitudinal view. Synovitis (S) appears as a hypoechoic area, the effusion (E) appears as an anechoic area and vascularity is demonstrated by power Doppler positivity.
 
Anterolateral/axial view. Synovitis (S) appears as a hypoechoic area, the effusion (E) appears as an anechoic area and vascularity is demonstrated by power Doppler positivity.
 
1ml of purulent synovial fluid was drained under ultrasound guidance. Culture yielded Staphylococcus aureus. Polarised light microscopy revealed urate crystals.
 
Joint space narrowing of the tibitalar joint with erosion of the articular surface of the distal fibula.
 
AP radiograph of the left ankle taken 3 months later showing progressive joint space reduction and increasing erosions/destruction.
 
Sagittal T2 sequence showing joint effusion and rapidly progressive periarticular joint destruction involving the talus, distal tibia and fibula with oedema of the subarticular bone marrow supports a diagnosis of a septic or inflammatory arthropathy.
 
Venous phase. There is intense uptake in both venous and delayed images in the left ankle, predominantly in the distal end of the tibia. This is consistent with infection or severe inflammation.
 
Intense uptake in the left ankle, and in particular the distal tibia on the delayed phase scan indicating infection, or any form of severe inflammation.
 
Increased uptake of tracer in the left ankle, predominantly in the distal tibia is suggestive of infection or severe inflammation/arthritis.
 
 
 
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