CITW: Case 2

Two cases this week! Thank you to Dr. David Kaplan for submitting the first case, while the second case was one seen by myself and Dr. Paul Cheung.

Case 1:

58 y/o male sustained blunt force trauma to the lateral aspect of his right knee. On exam, there is a mild right knee effusion, but no obvious deformities. Pain with ROM. Neurovascularly intact. No ligamentous laxity appreciated. X-rays of the right knee are obtained:

Kap Knee

Case 2:

22 y/o male sustained a gunshot wound to the right knee. On exam, there is an entrance wound on the posterior-lateral aspect of the knee, but no exit wound. There is pain with ROM of the knee and a mild effusion is appreciated. No obvious deformities. Neurovasculary intact. No ligamentous laxity appreciated. Initial plain films demonstrate the bullet lodged in the mid-thigh. Physical exam findings and x-rays of the right knee:

Knee

TR Knee

Given concern for an open joint, an aspiration is performed prior to irrigation, and the following aspirate is obtained:

LHA1

What’s the diagnosis?

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