Labs were obtained to aid in fever work up.

• CBC showed a leukocytosis of 30k, mild anemia, and no thrombocytopenia.
• UA negative for UTI. Ketonuria present. Pt was hydrated with a total of 1000cc NS.
• CRP was elevated at 23.
• ESR was elevated at 121.

After evaluation of the patient, the orthopedic specialist expressed low suspicion for a septic joint and recommended an outpatient follow up appointment at the orthopedic clinic.

Despite the specialist’s recommendations, the patient was admitted to the pediatric floor for suspicion of a septic shoulder. Concern for joint infection was discussed with the pediatric service with recommendation for orthopedic consultation upon patient arrival to the floor. Antibiotics were held until further work up was performed.

The pediatric department in consultation with orthopedics obtained an MRI. Some key images are shown at left.

What do you see on the MRI? Continue to NEXT page for conclusion