0:01

The, um, MRI can also try to help us determine

0:04

between atypical

0:06

and typical organisms as far as you know,

0:10

what the infectious agent is.

0:12

So I like to say that this slide is my TB or not Tob slide.

0:18

And on the left hand image is the patient with tuberculosis.

0:21

In this axial image, we can see the inflammation and t

0:26

and tenosynovitis or, and bursitis of the ulnar

0:30

and also radial bursa.

0:32

However, there is one key feature is these low signal

0:36

intensity foci that are coursing in

0:39

inside both of these bursa.

0:42

And this is an example of the granulomatous process

0:46

that is associated with tuberculosis in contradistinction.

0:51

This is a pyogenic septic bursitis, um,

0:54

in the 66-year-old man with wrist pain and swelling.

0:58

And we see the same NAR bursitis.

1:01

However, we can see

1:02

that on the T two weighted sequence it's much more

1:05

homogeneous in its T two hyperintensity.

1:09

And following the administration of intravenous contrast,

1:13

we see more of this peripheral, um, uh,

1:17

peripheral enhancement

1:18

that without any intraarticular bodies.

1:21

So sometimes this can help us try to differentiate between,

1:26

um, a atypical organism versus a typical organism.

1:31

However, ultimately it will come to, uh, the decision

1:36

of a histologic sampling

1:38

and sending a culture to microbiology, which brings us

1:43

to yet another collection.

1:45

This one is fresh off the press from this week.

1:48

We were asked to, uh, aspirate this collection.

1:52

Uh, for on this, uh, patient has had a long history

1:56

of, um, a very, very terrible summer with, um,

2:01

a total hip arthroplasty that was complicated by a greater,

2:05

uh, TRO enteric infection, had it washed out an

2:08

outside hospital and has just recently completed seven weeks

2:12

of anti IV antibiotics now presenting with a new fever

2:16

as they switched him over to a PO antibiotic.

2:21

We are the CT scan with intravenous contrast

2:23

as this slightly peripherally enhancing collection just

2:27

superficial to the greater trocanter.

2:30

And of course we were asked to biopsy it

2:33

and aspirate it later

2:35

and we thought it was going to give us a lot of, uh, fluid.

2:40

Um, but when we got to ultrasound, this is what we saw.

2:44

So instead of an ANA coa collection, which would be, um,

2:48

more something that is potentially drainable,

2:51

we saw this very hypoechoic collection with very minimal,

2:56

um, minimal hyper vascularity, which

2:58

I'm not showing you here.

3:01

And of course we're not gonna know for sure

3:03

until we stick a needle in there.

3:05

And of course, we stuck a very large, um, bore needle inside

3:10

and actually put in a UI catheter

3:13

and nothing came out just like maybe two drops of kind of,

3:17

uh, whiteish fluid.

3:18

Unfortunately, this was a sterile collection

3:22

and the patient is going to be treated as such.

3:25

So the second recommendation of the panel, uh, was

3:29

to actually remove additional ambiguous terminology like

3:33

flagman and this Drainable collection

3:36

because you can sometimes see

3:38

likeness collections in the setting

3:40

of inflammatory conditions as well.