J Korean Soc Radiol.  2011 Apr;64(4):369-373. 10.3348/jksr.2011.64.4.369.

Pyogenic Arthritis of the Ankle Joint Following a High-Voltage Electrical Burn in the Lower Extremity: A Case Report

• Kim KS
• Lee GK
• Suh KJ
• Kang IW
• Hwang DH
• Lee ES
• Min SJ
• Han YM

• KMID: 1443541
• DOI: http://doi.org/10.3348/jksr.2011.64.4.369

Abstract

A high-voltage electrical burn caused extensive deep muscle injuries beneath a relatively small skin wound at the contact point. Hidden, undetected deep muscle injuries have a tendency for progressive tissue necrosis, which can lead to major amputations or sepsis. The radiologic features of this rare, sometimes life-threatening injury have occasionally been described in the literature. However, to the best of our knowledge, there have been no reports on a case of pyogenic arthritis of the ankle joint following a high-voltage electrical burn involving the lower extremity. We report a case of the pyogenic arthritis of the ankle joint following a high-voltage electrical burn involving the lower extremity.

MeSH Terms

Amputation
Angiography
Animals
Ankle
Ankle Joint
Arthritis
Arthritis, Infectious
Burns
Burns, Electric
Lower Extremity
Magnetic Resonance Imaging
Muscles
Necrosis
Sepsis
Skin

Figure

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  Fig. 1 A 38-year-old man with high-voltage electrical burn. Conventional angiography of the left lower extremity shows complete occlusion of distal anterior tibial and dorslis pedis arteries. There is a normal flow of the posterior tibial artery (arrow).

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  Fig. 2 A. Axial T2-weighted (3600/109) turbo spin-echo MR image shows a heterogenous high signal intensity in the entire anterior muscle groups (asterisk) and flexor hallucis longus (FHL) muscle (open asterisk). There is a large anterior defect of the skin and subcutaneous tissue in the distal one-third of the lower leg (arrowhead). B-D. Gadolinium-enhanced axial (B, C) and sagittal (D) T1-weighted spin-echo MR images obtained with fat saturation show peripheral rim enhancement in the entire anterior muscle groups (asterisks) and part of FHL muscle (open asterisk), representing nonperfused and nonviable areas of edematous muscles. There is diffuse enhancement of FHL muscle (open arrows) at the proximal level, representing perfused and viable area of edematous muscle.

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  Fig. 3 Bone scan shows increased uptake in the left ankle joint (arrow).

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  Fig. 4 Gadolinium-enhanced sagittal T1-weighted spin-echo MR image obtained with fat saturation shows thick irregular synovial enhancement (asterisks) and marrow enhancement (open asterisks) in the ankle joint, representing pyogenic arthritis.

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