Male, 76 years old, status post kidney transplant with complicated postoperative course, now with gram-negative bacteremia. PET scan showed uptake in the left shoulder concerning for tracking up the neck. Tracking edema and/or fluid is evident within the fascial planes of the left upper chest wall, supraclavicular fossa and neck. More specifically, the abnormal signal extends from the pectoral region into the supraclavicular fossa, around the clavicle, with involvement of the visceral space and extension along the strap muscles of the neck at least to the level of the larynx. No discrete collections are seen.Patchy abnormal signal is also seen within the marrow of the clavicle. Marked degeneration of the sternoclavicular joints is seen with large joint effusions. Large bilateral pleural effusions are demonstrated. A 2-cm T2 hyperintense nodule is evident within the subcutaneous tissues of the left upper back, a nonspecific finding. Bone marrow signal characteristics are generally T1 hypointense which may reflect chronic renal dysfunction. An 8 mm cystic lesion within the left paracentral ventral epidural space at C1-2 may represent a degenerative or synovial cyst. There is multilevel disc degeneration most severely affecting the C2-3 level where there appears to be at least mild spinal canal stenosis. The right vertebral artery flow void is not well visualized which may reflect occlusion or slow flow.
Tracking edema and/or fluid is seen involving the left upper chest, supraclavicular fossa and left neck. These findings would be compatible with cellulitis. No definite evidence of an abscess is seen.Abnormal marrow signal involving the left clavicle raises concern for the possibility of osteomyelitis.