63-year-old female with persistent MRSA bacteremia. Evaluate for recurrent infection/abscess. Suboptimal examination secondary to patient motion artifact. Again seen is a collection fluid between the deltoid muscle and anterior aspect of the humeral head. Based on the fat-suppressed T2-weighted imaging, the collection appears similar to the prior study, however, the collection is now better delineated on the postcontrast images. It measures approximately 4.0 x 1.0 cm in the transverse dimension and 3.5 cm in the craniocaudal dimension. Again, while these measurements are larger than the stated on the previous examination, the collection appears similar in size to the prior study on the corresponding T2-weighted imaging. There are foci of signal void within this fluid collection consistent with foci of internal gas. There is enhancement of the soft tissue surrounding this collection. There is additional enhancement of the subdeltoid bursa laterally and posteriorly with small pockets of nonenhancing fluid. Overall the subdeltoid synovitis appears similar to the prior study based on the fat-saturated T2-weighted images. This fluid also appears to extend across a torn rotator cuff. Although there is a synovitis of the glenohumeral joint, there is only a small amount of fluid within the joint. There is a small collection of nonenhancing fluid noted beneath the coracoid process perhaps representing the coracoid bursa. Also again seen is a collection of nonenhancing fluid within the anterior subcutaneous fat of the shoulder with similar measurements when compared to the prior study. Again seen are foci of signal void consistent with air within this fluid collection. There is edema and enhancement of the underlying musculature reflecting inflammation. There is also edema and enhancement of the rotator cuff musculature. This edema is comparable to that seen on the prior examination. There are small foci of abnormal signal intensity and enhancement within the greater tuberosity of the humerus which are probably degenerative in etiology. We see no specific findings to suggest osteomyelitis.
Inflammatory changes of the shoulder with fluid collections as described above. While the fluid collections are better defined on the current study due to the presence of contrast-enhanced sequences, their overall size appears similar to the prior study on the fat-saturated T2-weighted images. 