52-year-old female with history of HIV, history of left shoulder abscess, x-ray with gas in left shoulder, worsening pain, swelling, erythema of left shoulder. Evaluate for abscess, osteomyelitis. There is a collection in the subcutaneous soft tissues lateral to the proximal humerus extending from the level of the humeral head to the mid humeral diaphysis and centered within the deltoid musculature. The mass demonstrates a heterogeneously hyperintense signal to skeletal muscle on T2-weighted images, intermediate to slightly hyperintense signal to skeletal muscle on T1-weighted images with rim as well as internal multiloculated enhancement after intravenous contrast demonstration. The mass contains internal foci of low signal intensity on T1 and T2-weighted images most likely gas. The mass measures 4.5 cm (anteroposterior) x 3.2 cm (mediolateral) by at least 7 cm (craniocaudal). There is a smaller mass with similar imaging features anterior to the subscapularis tendon measuring 8 mm x 5 mm. There are multiple masses in the right axilla which demonstrate low signal intensity to skeletal muscle on T1-weighted images, hyperintense signal to skeletal muscle T2-weighted images and enhances after intravenous contrast administration; these are most compatible with lymphadenopathy as seen on prior CT study overall appearance grossly similar in size allowing for differences in imaging technique.ROTATOR CUFF: Intermediate signal intensity of the supraspinatus tendon indicating tendinosis. The supraspinatus muscle appears normal. The remaining rotator cuff tendons and muscles appear normal.SUPRASPINATUS OUTLET: No significant abnormality noted. GLENOHUMERAL JOINT AND LABRUM: Glenohumeral joint alignment is anatomic. The glenoid labrum appears grossly normal on this nonarthrogram study. There are no MRI findings to suggest underlying osteomyelitis. Heterogeneous signal intensity of the bone marrow of the proximal humerus most compatible with residual red marrow.BICEPS TENDON: The long head of the biceps tendon appears normal.ADDITIONAL
1. Findings compatible with abscesses within the soft tissues adjacent to the left humerus, the largest of which is located lateral to the humerus with measurements provided above. No MRI findings to suggest osteomyelitis.2. Glenohumeral joint effusion with associated synovitis.3. Marked left axillary lymphadenopathy overall appearing grossly similar to prior CT study allowing for differences in imaging modality.4. Tendinosis of the supraspinatus tendon.