Soft-Tissue Gas Can Signify Life-Threatening Conditions.

Abstract

The appearance of gas on a diagnostic image usually grabs the immediate attention of an orthopaedist. Gas in the soft tissues can arise from gas-forming infectious organisms or from mechanical abnormalities caused by degenerative conditions or injuries. As this month’s “Case Connections” makes clear, when gas is observed in tissue, it’s crucial for clinicians to make early and definitive determinations of etiology, because some infections associated with this phenomenon can be very lethal very quickly. In the May 27, 2015 edition of JBJS Case Connector, Sakamoto et al. report on a thirty-three-year-old woman with a three-month history of shoulder pain who turned out to have a not-very-serious gas-containing ganglion cyst. Physical examination revealed moderate infraspinatus muscle atrophy. Radiographs appeared normal, but MRI showed a gas-containing cyst at the spinoglenoid notch that extended toward the posterosuperior aspect of the glenoid labrum. Nerve conduction studies revealed delayed conduction of the suprascapular nerve and decreased voluntary electrical potentials in the supraspinatus and infraspinatus muscles. Results of blood work were not suggestive of an inflammatory condition. After three months of conservative treatment, the pain and nerve dysfunction persisted, and the patient underwent open cyst excision and arthroscopic evaluation. The authors’ decision to do an open excision was based on concern that their patient’s condition might have had an infectious etiology. Arthroscopy revealed a partial detachment of the posterosuperior labrum from the glenoid, and the surgeons arthroscopically debrided the …