A 67-year-old man presented to the emergency department reporting fever, malaise, and left lower-extremity pain. He stated that, at 6 weeks before presentation, he started having nonspecific atraumatic leg pain and was subsequently found to have an occlusive deep venous thrombosis in the left femoral, popliteal, posterior tibial, and peroneal veins and was ultimately discharged with instructions to take oral anticoagulation. The patient continued to have an increase in pain and was unable to ambulate, so he presented to the emergency department. A computed tomographic (CT) pulmonary embolism torso study was ordered to rule out pulmonary embolus (Fig. 1).
On examination, the patient was found to have diffuse swelling of the left lower extremity extending to the ankle. He also was found to have an area of fluctuance over the medial left knee and severe pain with both active and passive motion. Joint aspiration of the knee produced 40 mL of fluid. A CT scan of the left lower extremity demonstrated peripherally enhancing multilocular complex fluid collections throughout the deep spaces of the thigh (Fig. 2) and heterogenous intramedullary findings with extensive micronodular erosion of the cortex about the left femoral diaphysis (Fig. 3).
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