62-year-old male with right shoulder subcutaneous abscess after shoulder arthroscopy. Since the prior study the patient has undergone surgery with suture anchors in the humeral head and foci of metallic susceptibility artifact in the surrounding soft tissues. There is a skin defect along the superolateral aspect of the shoulder, perhaps representing a prior arthroscopy portal, with abnormal signal intensity extending from the defect through the subcutaneous fat and the lateral fibers of the deltoid into the subdeltoid bursa. There is rim-enhancing fluid within the subdeltoid bursa that communicates with a heterogeneous glenohumeral joint effusion via a full-thickness tear of the rotator cuff involving the infraspinatus and supraspinatus with surrounding enhancement indicating inflammation. These findings are concerning for septic arthritis/subdeltoid bursitis. There is erosion of the humeral head along the superolateral aspect with edema extending along one of the suture anchors. There is edema within the supraspinatus and infraspinatus muscles. There is retraction of much of the infraspinatus to the level of the glenohumeral joint with fluid extending into the fibers of the retracted tendon. There is a small interstitial tear of the subscapularis. Osteoarthritis affects the acromioclavicular joint but we see no findings to suggest infection of the joint. There is a tear of the superior labrum. The tendon of the long head of the biceps is not visualized within the rotator interval perhaps related to prior tenotomy. Enhancement within the bicipital groove may reflect a tenosynovitis. Mild edema is identified within the deltoid muscle.
Findings suggestive of septic glenohumeral joint arthritis/subdeltoid bursitis and rotator cuff tear as described above. These findings were relayed to Dr. Eleswarapu via phone at 10:50 AM on 12/4/2015