The Use of Ultrasonography in Expediting Septic Joint Identification and Treatment

Abstract

This case report describes the use of ultrasonography in the identification of a joint effusion to guide diagnosis and management of septic arthritis. Our patient presented with pain, swelling, and erythema of the right thumb after having punctured her thumb with a cactus thorn. Results of physical examination demonstrated tenderness and restricted range of motion. Initial imaging with plain films was unrevealing, without bony and soft tissue abnormalities; however, ultrasound imaging of the interphalangeal joint revealed a focal effusion, and the patient was started on empiric Keflex. Because a focal effusion was visualized with ultrasonography, despite negative x-ray imaging, our patient underwent expedited surgical incision and drainage, foregoing joint aspiration. Intraoperative cultures grew Enterobacter 3 days after surgery, and the empiric antibiotic was adjusted to reflect sensitivities. At 2-wk follow-up, our patient showed near-complete resolution of her symptoms. This case report demonstrates the utility of ultrasonography in the early diagnosis of septic arthritis with the presence of a joint effusion that expedited successful treatment by foregoing joint aspiration in lieu of surgical intervention.

Diagnostic use of superb microvascular imaging in evaluating septic arthritis of the manubriosternal joint: A case report

“…Although ultrasound imaging of septic arthritis cannot be used as an absolute diagnostic modality, it enables early identification of both intra-articular and extra-articular abnormalities before significant cartilage lysis occurs. Ultrasound imaging or greyscale ultrasound of an intra-articular anechoic effusion of multiple internal echoes with distention of the joint capsule is highly suggestive of septic arthritis of the synovial joints[ 24 , 25 ]. The thickness of the synovia and the joint capsule is not specific to septic arthritis, but intra-articular synovial hypertrophy with remarkable PD signals suggests acute active synovitis[ 26 , 27 ].…”

“…The early appearance of bone erosion of the joint suggests that arthritis is suppurative[ 27 ]. To sum up, ultrasound findings such as joint effusion, intra-articular synovial hypertrophy with remarkable PD signals, and irregularity of the bony margins may support the clinical suspicion of infection[ 24 - 27 ].…”

“…SMI allows for clearer detection of synovial hypertrophy and active vascularity at an early stage of the disease than conventional PD. All possible ultrasound changes according to the literature[ 1 , 12 , 24 - 27 ], our own experience, and this case data are summarised in Table 1 (we recommend additional studies to determine the sensitivity and specificity of SMI in diagnosing septic arthritis). At the early stage of confirming a diagnosis, vascularity needs to be checked by an experienced musculoskeletal sonographer.…”

Septic arthritis of the hand: Current issues of etiology, pathogenesis, diagnosis, treatment

“…Technetium-, gallium-, and indium-labeled white blood cell scans are helpful in identifying acute osteomyelitis before the aforementioned changes can be detected on plain radiographs[ 33 ]. Ultrasound examination makes it possible to detect intra-articular effusion, and is also useful for pointing the needle when puncturing small joints of the hand[ 5 , 34 , 35 ]. MRI is a useful diagnostic tool to visualize joint effusion, its distribution, and the destruction of soft tissues and osteochondral structures of the joint.…”