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Fig. 1 Anteroposterior radiograph of the right clavicle of a young girl who was seen after a motor vehicle accident and originally diagnosed as having a “right clavicular fracture.”

AAOS Now

Published 4/1/2011

What’s your Diagnosis?

In this feature, AAOS Now publishes a series of images, challenging readers to diagnose the condition depicted. The images for this month’s challenge were submitted by Tyler Austin Cannon, MD, a resident member at the University of Tennessee–Campbell Clinic. He provides the following information:

Ten days after a motor vehicle accident (MVA), an 11-year-old girl with her right arm in a sling comes to the office for evaluation of what was diagnosed as a “right clavicular fracture” at an outlying facility. An obvious deformity and abrasion over the midclavicle can be seen and tenderness is felt along the middle third.

She has slight limitation of right shoulder range of motion, and her parents report that before the MVA she had no limitation of activities and no pain along the right clavicle. An anteroposterior radiograph is shown. (Fig. 1) What is your diagnosis?

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Fig. 1 Anteroposterior radiograph of the right clavicle of a young girl who was seen after a motor vehicle accident and originally diagnosed as having a “right clavicular fracture.”
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Fig. 2 MRI scan (coronal STIR with fat saturation).

Did you get it right?
Last month, John M. Purvis, MD, provided a series of images (Fig. 2) and information on a 10-year-old overweight female who had complained of right hip pain for one week. She had no previous history of injury, but had recently taken antibiotics for an ear infection. The examination showed pain on internal rotation of the hip and lab results showed elevated inflammatory markers (erythrocyte sedimentation rate [ESR] = 85; C-reactive protein [CRP] = 3.8).

According to Dr. Purvis, “Obturator pyomyositis (or “tropical pyomyositis”) seemed the best fit for this girl. She did have some bone edema in the ischium, but the abscess formation was within the obturator muscle group. She had a CT-guided needle aspiration; cultures subsequently grew methicillin-resistant Staphylococcus aureus. She was treated with intravenous antibiotics and responded well. Follow-up plain films revealed no bone abnormalities.”

Do you have a challenging case you’d like to submit for publication? E-mail a short case description and any accompanying images to aaoscomm@aaos.org

View previous challenges at www.aaosnow.org