Reason: Evaluate for shoulder involvement of infection/abscess History: abscess, previous septic joint The previously described heterogeneous abnormal signal collection in the left deltoid musculature, posterior and lateral to the humeral head/neck as well as proximal diaphysis, compatible with abscess, has decreased in size when compared to the previous study, currently measuring 4 x 3 cm, previously 4.5 x 3.2 cm. Additionally, focal fluid collections within this lesion have also decreased in size, the largest currently measures 13 x 6 mm. Within this collection are increased T1 signal intensity regions, which suggests subacute blood products or granulation tissue as well as amorphous decreased T1 signal intensity, which may represent a combination of scar tissue and chronic blood products. There is abnormal enhancement which extends from this collection within the deltoid muscle to the subcutaneous surface, which suggests a draining superficial wound/ulceration. Edema and inflammation also extends inferiorly along the deltoid musculature to its insertion on the humerus. There are multiple enlarged supraclavicular and axillary lymph nodes, as seen previously.ROTATOR CUFF: There is undersurface tearing with delamination/retraction of the fibers of the supraspinatus and infraspinatus, similar to prior study. There is evidence of tendinosis of the subscapularis tendon. The rotator cuff musculature is normal. SUPRASPINATUS OUTLET: There is a small amount of fluid in the subacromial-subdeltoid bursa.GLENOHUMERAL JOINT AND LABRUM: Glenohumeral joint alignment is anatomic. There is an effusion within the glenohumeral joint which demonstrates synovial enhancement compatible with synovitis, however, the amount of fluid has decreased when compared to the prior study. There are erosions in the humeral head which appear slightly more pronounced than on the prior study. There is mild edema in the base of the coracoid and humeral head which is nonspecific and may be reactive due to adjacent synovitis. There is also mild signal abnormality in the humeral diaphysis, which is nonspecific but may represent serous atrophy in the setting of HIV.BICEPS TENDON: The long head of the biceps is intact, however there is evidence of synovitis within the biceps tendon sheath.
1.Overall decrease in size of the fluid collections in the deltoid musculature as above.2.Decreased glenohumeral joint effusion with synovitis.3.Erosions in the humeral head appear more slightly prominent than on the previous study.4.Supraclavicular and axillary lymphadenopathy and other findings as above.