63 year old female with pyomyositis with abscess of the left shoulder status post surgical incision and drainage with persistent MRSA bacteremia. Evaluate for recurrence or osteomyelitis. Suboptimal examination secondary to patient motion artifact.There is a small collection of fluid signal intensity between the deltoid muscle and the lesser tuberosity of the humerus that measures approximately 20 x 8 mm in the transverse dimension and 20 mm in the craniocaudal dimension in the approximate location of the suspected abscess seen on the prior study. There is edema within the soft tissues adjacent to this collection as well as foci of gas intensity. We cannot determine if this represents recurrence of abscess or simply postoperative changes. There is heterogeneous material within the remainder of the subdeltoid bursa similar in distribution to that seen on the prior examination that may represent a combination of synovitis, postoperative gas and blood products as well as a small amount of fluid. However, we cannot exclude the possibility of residual infection. There is a new collection of lobulated heterogeneous but predominantly fluid signal intensity within the subcutaneous fat of the shoulder anterior to the deltoid and pectoralis musculature that measures approximately 40 x 17 mm in the transverse dimension and 40 mm in the craniocaudal dimension which contains a large focus of signal void that presumably represents air. We presume this represents early postoperative seroma formation, although we cannot exclude the possibility of residual infection. Additional foci of signal void within the anterior soft tissues of the shoulder presumably represent gas related to the patient's recent surgical history. There is a small amount of fluid within the posterior aspect of the glenohumeral joint, but the volume of the fluid appears smaller than that seen on the prior study. There are small foci of signal abnormality within the greater tuberosity and the posterior aspect of the humeral head which are likely degenerative in etiology. We see no findings to suggest osteomyelitis. Again seen is edema within the rotator cuff musculature, particularly the infraspinatus, indicating inflammation, appearing similar to the prior study. There is mild edema within the anterior fibers of the deltoid muscle which may be postsurgical in etiology. We see no findings to suggest intramuscular abscess formation. The supraspinatus and infraspinatus tears appear similar to the prior study. Osteoarthritic changes affect the acromioclavicular joint, appearing similar to the prior study. Glenohumeral joint alignment is within normal limits. Evaluation of the labrum is limited due to patient motion artifact. The tendon of the long head of the biceps is within normal limits.
Inflammatory changes of the shoulder as described above with a small fluid collection between the deltoid muscle and lesser tuberosity of the humerus as well as heterogeneous material within the subdeltoid bursa, which could be postoperative in etiology, although we cannot exclude the possibility of residual infection. There is a new fluid collection in the anterior soft tissues of the shoulder which is presumably postoperative in etiology, although we again cannot exclude the possibility of residual infection.