Saudi Journal of Medicine and Medical Sciences

IMAGE QUIZ
Year
: 2018  |  Volume : 6  |  Issue : 1  |  Page : 48--52

Rare findings in a patient after fall on his right shoulder


Abid Hussain Gullenpet 
 Department of Radiology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia

Correspondence Address:
Abid Hussain Gullenpet
Department of Radiology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam
Saudi Arabia




How to cite this article:
Gullenpet AH. Rare findings in a patient after fall on his right shoulder.Saudi J Med Med Sci 2018;6:48-52


How to cite this URL:
Gullenpet AH. Rare findings in a patient after fall on his right shoulder. Saudi J Med Med Sci [serial online] 2018 [cited 2021 Mar 6 ];6:48-52
Available from: https://www.sjmms.net/text.asp?2018/6/1/48/220796


Full Text

A 53-year-old male presented with pain in the right shoulder after a fall on his right side. The patient was not diabetic, hypertensive or suffering from any other disease. On physical examination, it was found that there was tenderness in his right shoulder. In addition, the shoulder was mildly swollen and warm, with no evidence of ecchymosis. The movement of the shoulder joint was restricted. The rest of the examinations were normal. The laboratory investigations were within normal limits. An X-ray of the shoulder was taken [Figure 1].{Figure 1}

 Questions



What are the interpretations of this X-ray?What is the final diagnosis?

 View Answer

 Answer



See the answer in page 52.

 Answers



The anterior–posterior X-ray of the erect shoulder shows subtle fracture of greater tuberosity and a fat–fluid level.The final diagnosis is lipohemarthrosis.

 Discussion



Lipohemarthrosis results from an intracapsular fracture in which fat from the bone marrow is released into the joint space and mixes with the blood (hemorrhage).[1],[2] Lipohemarthrosis is most commonly observed in traumatic knee injuries including distal femoral fracture and tibial plateau fracture. In fact, lipohemarthrosis is observed in about 40% of all intracapsular fractures of the knee.[2],[3],[4] However, it is not only limited to the knee and can also be seen in the shoulder, hip and elbow joints.[5]

Because fat has a lower density than blood, they separate and form a fat–fluid level, with the blood layer lying inferiorly and the fat layer superiorly.[2] This fat–fluid level can usually be identified on any horizontal beam radiographs, provided that the beam is tangential to the fat–blood interface.[3] However, in the glenohumeral joint, it is unusual to detect lipohemarthrosis on plain radiographs, and the fat–fluid level can only be detected in an erect view. In case of simple hemarthrosis, the fat–fluid level can be seen on an MRI. However, to confirm the diagnosis of lipohemarthrosis, the fat layer should demonstrate its respective characteristics (e.g., drop signal on fat–sat sequences).[6]

Management

In patients with undisplaced fracture and lipohemarthrosis, the area is first immobilized with a sling for 4–6 weeks to manage the fracture. There is no specific treatment required for lipohemarthrosis as the fat–fluid interface would resolve itself in due course.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Kling DH. Fat in traumatic effusions of the knee joint. Am J Surg 1929;6:71-4.
2McConnell M, Cohen H, Scuderi M. Non-displaced distal radius fracture with fat-fluid levels in the adjacent extensor tendon sheaths on MRI. Skeletal Radiol 2013;42:1761-5.
3Davis DL, Vachhani P. Traumatic Extra-capsular and intra-capsular floating fat: fat-fluid levels of the knee revisited. J Clin Imaging Sci 2015;5:60.
4Colletti P, Greenberg H, Terk MR. MR findings in patients with acute tibial plateau fractures. Comput Med Imaging Graph. 1996;20:389-94.
5Costa DN, Cavalcanti CFA, Sernik RA. Sonographic and CT findings in lipohemarthrosis. Am J Roentgenol. 2007;188:W389.
6Gaillard F. Lipohaemarthrosis of the shoulder [Internet]. Available from: https://radiopaedia.org/cases/lipohaemarthrosis-of-the-shoulder. [Last accessed on 2017 Nov 27].