Sternoclavicular joint septic arthritis in a healthy adult: a rare diagnosis with frequent complications

Abstract. We report a case of complicated sternoclavicular joint septic arthritis in a previously healthy adult with no risk factors. An 83-year-old female presented to the emergency with a 1-week history of right shoulder pain followed by fever and prostration in the last 48 h. Computed tomography (CT) scan findings were consistent with right sternoclavicular joint (SCJ) septic arthritis complicated by periarticular abscess. Emergent surgical debridement was performed by a surgical team composed of orthopaedic and thoracic surgeons, followed by 6 weeks of antibiotic treatment. This case highlights the diagnosis and surgical treatment of a rare septic arthritis location but with frequent complications as well as the importance of multidisciplinary collaboration.

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Spontaneous Bilateral Sternoclavicular Joint Septic Arthritis and Lumbar Discitis: An Unusual Case in a Healthy Adult

Case Reports in Orthopedics ◽

10.1155/2017/7101694 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4

Author(s):

Georgios Mamarelis ◽

Mohammad Zain Sohail ◽

Athanasios Mamarelis ◽

Hassan Fawi ◽

Jehangir Mahaluxmivala

Keyword(s):

Septic Arthritis ◽

Healthy Adult ◽

Joint Infection ◽

Good Condition ◽

Rare Condition ◽

Sternoclavicular Joint ◽

Intravenous Antibiotics ◽

History Of ◽

Image Investigation ◽

Ct And Mri

Introduction. Septic arthritis of the sternoclavicular (SC) joint is a rare condition. Typically, it presents in patients with risk of infection and is usually unilateral. In this report, we describe a case of spontaneous bilateral sternoclavicular joint infection of an otherwise healthy adult. Case Presentation. A 67-year-old man presented in our hospital complaining of 2-week history of neck and chest pain which was radiating to his shoulders bilaterally. Clinical examination revealed erythema and swelling of the sternoclavicular area. Inflammatory markers were raised. Image investigation with CT and MRI was undertaken and verified the presence of bilateral sternoclavicular joint infection. The patient received prolonged course of intravenous antibiotics since his admission. The patient was discharged in a good condition and followed up in clinic. Conclusion. High index of clinical suspicion of SC joint infection is important for early diagnosis to avoid further complications.

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Additive value of positron emission tomography/computed tomography scan for detection of aortic tube graft infection: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa512 ◽

2020 ◽

Author(s):

Farnoosh Larti ◽

Mohammad Amin Khadembashiri ◽

Mehrshad Abbasi ◽

Alborz Sherafati

Keyword(s):

Computed Tomography ◽

Positron Emission Tomography ◽

Diagnostic Accuracy ◽

Ct Scan ◽

Graft Infection ◽

Emission Tomography ◽

Positron Emission ◽

Pet Ct ◽

History Of ◽

Pet Ct Scan

Abstract Background Diagnosis of aortic graft infection is challenging, and delayed diagnosis is associated with poor prognosis. Positron emission tomography/computed tomography (PET/CT) has improved diagnostic accuracy. Case summary A patient with a history of congenital heart disease was admitted due to fever. He had a history of four cardiac surgeries, including the Bentall procedure for endocarditis. Blood cultures were negative. A semi-mobile mass was detected in the distal portion of the aortic tube graft in echocardiography. PET/CT scan was used to confirm tube graft infection and to support proceeding to cardiac surgery. Discussion Using multimodality imaging, including PET/CT scan in combination with echocardiography, can improve diagnostic accuracy for the detection of aortic tube graft infection, infection of prosthetic valves, or intra-cardiac devices, especially in high-risk surgical cases.

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Abstract 14676: Landmark-based Functional Computed Tomography Reveals Diminished Left Atrial Appendage Contraction During Atrial Fibrillation

Circulation ◽

10.1161/circ.142.suppl_3.14676 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jonathan H Chung ◽

Gordon Ho ◽

Andrew Schluchter ◽

Francisco Contijoch ◽

Jonathan C Hsu ◽

...

Keyword(s):

Computed Tomography ◽

Atrial Fibrillation ◽

Ejection Fraction ◽

Sinus Rhythm ◽

Ct Scan ◽

Blood Volume ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

History Of

Introduction: The formation of thrombus in the left atrial appendage (LAA) and risk for systemic embolization may result in part from stasis and poor blood volume emptying during atrial fibrillation (AF). Functional 4-dimensional computed tomography (4DCT) is a promising technique to measure LAA ejection fraction and blood volume emptying. Hypothesis: We hypothesize that the LAA ejection fraction measured by 4DCT is decreased during AF compared to sinus rhythm. Methods: 256-slice 4DCT scans obtained in patients for coronary artery imaging or pre-procedurally for AF, VT or SVT ablation procedures were analyzed retrospectively. In each patient, LAA volumes were measured at multiple phases during one cardiac cycle using segmentation software (ITK-SNAP and Osirix MD). LAA ejection fraction was calculated as the difference between minimum and maximum volumes and was analyzed using Wilcoxon rank sum. Results: Out of 54 patients, 37 patients were in sinus rhythm and 17 patients were in AF. Between NSR vs. AF, mean age was 69.1±12.8 vs 73.2±11.5 years (p=0.13), 28% vs 36% female (p=0.54), LVEF was 58±11% vs 60±9% (p=0.95), and echo-derived left atrial volume index was 29.5±6.1 ml/m2 vs 41.7±12.8 ml/m2 (p=0.06). Patients who were in sinus rhythm during their CT scan had a higher LAA ejection fraction than those who were in AF (58±13% vs. 29±9%, p<0.0001). For patients who were in AF during their CT scan, there was no difference in LAA ejection fraction between patients with a history of paroxysmal AF compared to patients with a history of persistent AF (30±10% vs. 28±10%, p=0.75). Conclusions: Analysis of the LAA volumes using functional cardiac CT is a feasible method to quantify blood volume emptying from the LAA. Patients in AF were observed to have significantly decreased LAA ejection fraction and blood volume emptying compared to patients in sinus rhythm. Further studies are needed to determine whether this technique may improve personalized risk stratification for stroke.

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Computed Tomography Findings of Pulmonary Mycobacterium simiae Infection

Canadian Respiratory Journal ◽

10.1155/2017/6913564 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Ayeh Baghizadeh ◽

Payam Mehrian ◽

Poopak Farnia

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Pulmonary Infection ◽

Previous History ◽

Treatment Protocol ◽

Zonal Distribution ◽

Sputum Production ◽

History Of ◽

Nodular Lesions ◽

Mycobacterium Simiae

Nontuberculous mycobacterial (NTM) pulmonary infections can be quite similar to tuberculosis, both clinically and radiologically. However, the treatment protocol is not similar. Mycobacterium simiae is a rare cause of NTM pulmonary infection. Herein, we aimed to evaluate and compare the computed tomography (CT) scan findings of M. simiae infection in lungs. For this reason, thirty-four patients (n=34) with M. simiae lung infection were retrospectively evaluated. Diagnosis was confirmed by American Thoracic Society (ATS) guidelines and CT scans were reviewed in both lung and mediastinal windows. The average age of patients was 63±14.54 years and 52.9% were male. The majority of patients had cough (91.2%) and sputum production (76.5%). Clinically, 41.2% of patients had previous history of TB (14/34), 38.2% had cardiac diseases (13/34), and 35.3% had diabetes mellitus (12/34). The most common CT findings in our study were nodular lesions (100%) and bronchiectasis (85.29%). Regarding the severity, grade I bronchiectasis was the most prevalent. Other prominent findings were tree-in-bud sign (88.2%), consolidation (52.94%), and lobar fibrosis and volume loss (67.6%). There was no significant zonal distribution of findings. In conclusion, nodular lesions and bronchiectasis are the most frequent features in CT scan of M. simiae pulmonary infection.

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Multidetector Computed Tomography (MDCT) Evaluation of Traumatic Brain Injury in Head Trauma Patients in Tertiary Hospital of Eastern Region of Nepal

Birat Journal of Health Sciences ◽

10.3126/bjhs.v6i1.37636 ◽

2021 ◽

Vol 6 (1) ◽

pp. 1352-1357

Author(s):

Ajay Kumar Yadav ◽

Binit Dev ◽

Sushil Taparia ◽

Parvez Kumar ◽

Rakesh Mandal ◽

...

Keyword(s):

Computed Tomography ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Ct Scan ◽

Head Trauma ◽

Road Traffic ◽

Imaging Findings ◽

Intracranial Lesions ◽

History Of

Introduction: Traumatic brain injury (TBI) in patients with head trauma is common cause for emergency visits to hospital affecting all age groups. It is one of important leading cause of death and disability worldwide besides leading to neurological disease burden. Noncontrast enhanced Multidetector computed tomography (MDCT) is imaging modality of choice for detection of various intracranial lesions. Objectives: This study was done to analyse various imaging findings on MDCT in traumatic head injury patients along with association of CT findings with clinical manifestation and mechanism of injury. Methodology: In this ethically approved prospective study, CT scan was done in 224 consecutive patients with head injury from November 2020 to February 2021. The various imaging findings seen in CT scan were documented in proforma. The data collected was analyzed with appropriate statistical test and statistical significance was calculated. Results: Total of 224 patients with diagnosis of head injury were included in the study. The male to female ratio was 2.86 and most common age group involved was between 20-40years (41.1%). The most common mode of injury was road traffic accidents (57.6%) and most of the patients presented with history of altered sensorium (35.7%). About 47.3% patients showed abnormal findings on CT scan with scalp lesion was most common findings (82%) followed by skull fractures (54.7%) and cerebral contusions (43.4%). Patients with history of RTA had more abnormal CT scan (62%) than fall injury and physical assault. Statistically significant association seen between CT scan findings with Glasgow Coma Scale and RTA (P<0.05). Conclusion: The present study showed well documented role of CT scan in diagnosis of TBI besides detection of spectrum of intracranial lesions in patients with head trauma. Road traffic accident is most common mode of head injury with most of the victims are young middle age active male.

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Acute joint pain

Oxford Cases in Medicine and Surgery ◽

10.1093/oso/9780198716228.003.0033 ◽

2015 ◽

Author(s):

Hugo Farne ◽

Edward Norris-Cervetto ◽

James Warbrick-Smith

Keyword(s):

Risk Factors ◽

Septic Arthritis ◽

Cruciate Ligament ◽

Renal Stones ◽

Acute Onset ◽

Joint Function ◽

Prosthetic Joints ◽

History Of ◽

Common Risk Factors ◽

Anterior Cruciate

The ‘must exclude’ diagnosis is septic arthritis. Not only can it destroy articular cartilage within days if not treated (hence permanently reducing joint function), but it is also associated with a mortality of about 10% due to underlying bacteraemia. Remember that pain may be referred from elsewhere. For example, hip pathology may present as knee pain, and lumbar spine pathology may present as hip pain. The causes of a single, acutely painful joint include those shown in Figure 27.1, with larger font size highlighting those that are more common. • Pain. You should characterize the pain as for any other pain along the lines of SOCRATES (see Chapter 1). Pain that worsens with movement and improves with rest is likely to be non-inflammatory. An acute onset (hours) is consistent with septic arthritis, gout/pseudogout, and trauma. A more insidious onset is more common in conditions like bursitis and tendonitis, where the relevant anatomical structure becomes inflamed with overuse. Chronic onset suggests osteoarthritis (note that some rheumatologists prefer the term osteoarthrosis to reflect the fact that the inflammation is not the primary pathology). The severity of pain can usefully be assessed by asking about joint function—for example, can the patient weight bear? • Trauma. Mr Sullivan has already said he does not remember there being any trauma, but you must always ask and make sure. Even the slightest of knocks can cause significant pain. However, this does not exclude other diagnoses—trauma can precipitate infection or gout, for example. • Common risk factors for gout. There are many potential causes of gout, but the more common ones that you should ask about include use of thiazide diuretics, recent heavy alcohol intake, chronic renal failure, and chemotherapy (high cell apoptosis, leading to degradation of DNA and excess urate). A history of renal stones or previous episodes of gout also makes gout more likely. • Common risk factors for septic arthritis. Again there are many possible risk factors, but the key ones are immunosuppression (e.g. diabetes, HIV, steroid use) and any prosthetic joints. • Risk factors for haemarthrosis. Typically due to a coagulopathy (e.g. classically haemophilia), anticoagulant use (typically warfarin) or trauma (e.g. a ruptured anterior cruciate ligament in the knee).

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Prevalence of Coronary Heart Disease in Patients with Hemophilia: a Nationwide Study in Brazil.

Blood ◽

10.1182/blood.v114.22.3495.3495 ◽

2009 ◽

Vol 114 (22) ◽

pp. 3495-3495

Author(s):

Claudia Bley ◽

Fabio P S Santos ◽

Antonio E P Pesaro ◽

Ricardo Helman ◽

Sergio A Oliveira ◽

...

Keyword(s):

Risk Factors ◽

Surgical Treatment ◽

Factor Viii ◽

Antiplatelet Therapy ◽

Hemophilia A ◽

Factor Ix ◽

Hemophilia B ◽

Factor Activity ◽

Positive History ◽

History Of

Abstract Abstract 3495 Poster Board III-432 Background It is well known that patients with hemophilia (both A and B) have a lower incidence of coronary artery disease (CAD). However, patients with hemophilia may develop atherosclerosis, and with increases in life expectancy it is possible that the incidence of CAD may increase in these patients. There are no studies analyzing the prevalence of CAD in patients with hemophilia and possible risk factors. Aims To determine the prevalence of CAD in patients with hemophilia treated in Brazil. Methods All patients with hemophilia in Brazil receive therapy with Factor VIII or Factor IX at government-designed hemophilia centers. We thus contacted all centers in Brazil by e-mail and information from databases concerning health information for all patients was reviewed by the responsible physician at each center. A questionnaire about risk factors for CAD and history of coronary events was sent to patients that had a positive history of CAD. Results There are 6,881 patients registered with a diagnosis of hemophilia A and 1,291 patients with a diagnosis of hemophilia B in Brazil. Fifty-six percent of hemophilia centers answered the query, and information on 71.7% of patients with hemophilia A (4,934 patients) and 61.4% of patients with hemophilia B (792 patients) was reviewed. There were only 3 patients (0.05%) with a positive history of CAD. Their clinical characteristics are summarized in Table 1. During surgical treatment for CAD, replacement with Factor VIII and Factor IX was done by continuous infusion to increase Factor activity to 80-100%. Antiplatelet therapy was used in all patients at some point, and one patient (#1) developed hemarthrosis after two months of ASA. Patient #3 did not start antiplatelet therapy after CABG, and developed thrombosis of the graft. ASA and clopidogrel were started after percutaneous coronary angioplasty. Conclusion We found a very low incidence of CAD in hemophiliac patients, even after doing a nationwide survey that included more than 5,000 patients. No information about risk factors can be gleaned due to the small number of patients. Surgical treatment after increasing factor activity appears to be safe in such patients. Despite a theoretical risk for increased bleeding, therapy with antiplatelet agents appears to be necessary in hemophiliac patients with CAD. Disclosures: No relevant conflicts of interest to declare.

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Tooth in Intracranial Compartment after Traumatic Brain Injury

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0036-1597773 ◽

2017 ◽

Vol 36 (01) ◽

pp. 26-28

Author(s):

Benedito Pereira ◽

Radmila Holanda ◽

José Targino Neto ◽

Luciano Holanda

Keyword(s):

Computed Tomography ◽

Traumatic Brain Injury ◽

Surgical Treatment ◽

Brain Injury ◽

Foreign Body ◽

Ct Scan ◽

Frontal Sinus ◽

Case Reports ◽

Cranial Computed Tomography ◽

Skull Radiography

AbstractA 25-year-old patient was admitted to the emergency room presenting headaches after a traumatic brain injury (TBI) 30 days before, when he collided frontally with another driver. After a skull radiography, the presence of a foreign body was observed in the frontal sinus. A cranial computed tomography (CT) scan found that it was a tooth. The patient underwent surgical treatment for the removal of the tooth. Traumatic brain injury caused by non-missile penetrating objects is unusual, and has been described in case reports in the literature. To the best of our knowledge, no similar reports can be found in the literature.

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Clinical predictors of abnormal head computed tomography scan in patients who are conscious after head injury

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.193538 ◽

2017 ◽

Vol 08 (01) ◽

pp. 064-067 ◽

Cited By ~ 2

Author(s):

Rakesh Kumar Mishra ◽

Ashok Munivenkatappa ◽

Vasuki Prathyusha ◽

Dhaval P. Shukla ◽

Bhagavatula Indira Devi

Keyword(s):

Computed Tomography ◽

Head Injury ◽

Ct Scan ◽

Clinical Features ◽

Significant Risk ◽

Observation Study ◽

Head Ct ◽

Abnormal Head ◽

History Of ◽

Head Computed Tomography

ABSTRACT Background: Indication of a head computed tomography (CT) scan in a patient who remains conscious after head injury is controversial. We aimed to determine the clinical features that are most likely to be associated with abnormal CT scan in patients with a history of head injury, and who are conscious at the time of presentation to casualty. Materials and Methods: This is a prospective observation study of patients presented to casualty with history of head injury, and who were conscious, i.e., Glasgow Coma Scale (GCS) 15 at the time of evaluation. All patients underwent head CT scan. The CT scan was reported as abnormal if it showed any pathology ascribed to trauma. The following variables were used: age, gender, mode of injury (road traffic accident, fall, assault, and others), duration since injury, and history of transient loss of consciousness, headache, vomiting, ear/nose bleeding, and seizures. Logistic regression analysis was used to identify the clinical features that predicted an abnormal CT scan. Results: During the observation period, a total of 1629 patients with head injury were evaluated, out of which 453 were in GCS 15. Abnormal CT scan was present in 195 (43%) patients. Among all the variables, the following were found significantly associated with abnormal CT scan: duration since injury (>12 h) P < 0.001; vomiting odds, ratio (OR) 1.89 (1.23, 2.80), P < 0.001; and presence of any symptom, OR 2.36 (1.52, 3.71), P < 0.001. Conclusion: A patient with GCS 15 presenting after 12 hours of injury with vomiting or combination of symptoms has a significant risk of abnormal head CT scan.

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Early Onset of Coronary Artery Calcification in Women With Previous Preeclampsia

Circulation Cardiovascular Imaging ◽

10.1161/circimaging.119.010340 ◽

2020 ◽

Vol 13 (11) ◽

Author(s):

Laura Benschop ◽

Laura Brouwers ◽

Gerbrand A. Zoet ◽

Cindy Meun ◽

Eric Boersma ◽

...

Keyword(s):

Risk Factors ◽

Computed Tomography ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Coronary Artery ◽

Cardiovascular Risk Factors ◽

Odds Ratio ◽

Coronary Computed Tomography ◽

History Of ◽

Normotensive Pregnancy

Background: Preeclampsia, coronary artery calcification (CAC), and atherosclerotic plaque are risk factors for the development of cardiovascular disease. We determined at what age CAC becomes apparent on coronary computed tomography after preeclampsia and to what extent modifiable cardiovascular risk factors were associated. Methods: We measured cardiovascular risk factors, CAC by coronary computed tomography, and coronary plaque by coronary computed tomography angiography in 258 previously preeclamptic women aged 40-63. Results were compared to 644 age- and ethnicity-equivalent women from the Framingham Heart Study with previous normotensive pregnancies. Results: Any CAC was more prevalent after preeclampsia than after a normotensive pregnancy (20% versus 13%). However, this difference was greatest and statistically significant only in women ages 45 to 50 (23% versus 10%). The degree of CAC advanced 4× faster between the ages of 40 to 45 and ages 45 to 50 in women with a history of preeclampsia (odds ratio, 4.3 [95% CI, 1.5–12.2] versus odds ratio, 1.2 [95% CI, 0.6–2.3]). Women with a preeclampsia history maintained greater advancement of CAC with age into their early 60s, although this difference declined after the perimenopausal years. Women with a previous normotensive pregnancy were 4.9 years (95% CI, 1.8–8.0) older when they had similar CAC scores as previously preeclamptic women. These observations were not explained by the greater prevalence of cardiovascular disease risk factors, and the higher Framingham Risk Scores also observed in women with a history of preeclampsia. Conclusions: Previously preeclamptic women have more modifiable cardiovascular risk factors and develop CAC ≈5 years earlier from the age of 45 years onwards compared to women with normotensive pregnancies. Therefore, women who experienced preeclampsia might benefit from regular cardiovascular screening and intervention before this age. Registration: URL: https://www.trialregister.nl/trial/5406 ; Unique identifier: NTR5531.

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