Diabetic patient with painful swelling of the shoulder and arm

Kyriaki Tavernaraki, Petros Filippousis, Loukas Thanos


A 42-year-old female patient with known type II diabetes mellitus presented to the Emergency Department with significant swelling and increasing pain of the right shoulder-arm radiating to the axillary fossa and lateral chest wall. She had had the pain for 20 days. Fever (temperature 37.8°), significant swelling and signs of infection in the painful arm were noted on clinical examination. The laboratory tests were in keeping with sepsis with leukocytosis (WBC 30,000) and consequent diabetic ketoacidosis (blood glucose 420 mg/dL, pH 7,189, HCO3 7.8 mmol/L). An emergency CT scan of the chest-right shoulder was ordered.


diabetes; pyomyositis; Computed Tomography

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Bickels J, Ben-Sira L, Kessler A, et al. Primary pyomyositis. J Bone Joint Surg Am 2002; 21: 84: 2277-2286.

Crum NF. Bacterial pyomyositis in the United States. Am J Med 2004; 117(6): 420-428.

Christen L, Sarosi GA. Pyomyositis in North America: Case reports and review. Clin Infect Dis 1992; 15: 668-677.

Sadarangani S, Jibawi S, Flynn T, et al. Primary pyomyositis. Experience over 9 years in temperate Michigan. Infect Dis Clin Pract 2013; 21: 114-122.

Fan HC, Lo WT, Chu ML, et al. Clinical characteristics os staphypococcal pyomyositis. J Microbiol Immunol Infect 2002; 35: 121-124.

Fayad L, Carrino J and Fishman E. Musculoskeletal infection: Role of CT in the emergency department. RadioGraphics 2007; 27: 1723-1736.

Hayeri M, Ziai P, Shehata M, et al. Soft-tissue infection and their imaging mimics: From cellulitis to necrotizing fasciitis. RadioGraphics 2016; 36: 1888-1910.

Del Grande F, Carrino JA, Del Grande M et al. Magnetic resonance imaging of inflammatory myopathies. Top Magn Reson Imaging. 2011; 22(2): 39-43.

Schulze M, Kötter I, Ernemann U et al. MRI findings in inflammatory muscle diseases and their noninflammatory mimics. AJR Am J Roentgenol. 2009;192 (6): 1708-1716.

May DA, Disler DG, Jones EA, Balkissoon AA, et al. Abnormal signal intensity in skeletal muscle at MR imaging: Patterns, pearls, and pitfalls. RadioGraphics 2000; 20(suppl 1): S295-S315.

DOI: http://dx.doi.org/10.36162/hjr.v2i1.126


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