Algorithm for Synovial Fluid Analysis in Septic Arthritis - Flowchart
Algorithm for Synovial Fluid Analysis in Septic Arthritis - Flowchart Septic Arthritis Septic Arthritis
«Flowchart»

Diagnostic arthrocentesis: (always try to tap the joint dry)


Note which joint
Total volume of synovial fluid
Gross description of fluid, bloody or nonbloody

Diagnostic arthrocentesis: (always try to tap the joint dry)


Note which joint
Total volume of synovial fluid
Gross description of fluid, bloody or nonbloody

Diagnostic arthrocentesis: (always try to tap the joint dry)


Note which joint
Total volume of synovial fluid
Gross description of fluid, bloody or nonbloody


Note which joint
Total volume of synovial fluid
Gross description of fluid, bloody or nonbloody

Bloody fluid: Consider the following differential diagnosis of hemarthrosis:


Trauma with or without fracture
Over anticoagulation
Hemophilia
Other bleeding disorders
Pigmented villonodular synovitis or other tumors
Traumatic tap

Bloody fluid: Consider the following differential diagnosis of hemarthrosis:


Trauma with or without fracture
Over anticoagulation
Hemophilia
Other bleeding disorders
Pigmented villonodular synovitis or other tumors
Traumatic tap


Trauma with or without fracture
Over anticoagulation
Hemophilia
Other bleeding disorders
Pigmented villonodular synovitis or other tumors
Traumatic tap Bloody fluid

Nonbloody fluid: Note color, turbidity, and viscosity

Nonbloody fluid: Note color, turbidity, and viscosity

Nonbloody fluid

Markedly inflammatory fluid: Consider empiric antibiotic therapy pending culture results

Markedly inflammatory fluid: Consider empiric antibiotic therapy pending culture results

Markedly inflammatory fluid: Consider empiric antibiotic therapy pending culture results

Noninflammatory to moderately inflammatory fluid: Consider a broad differential diagnosis from OA to RA. However, septic arthritis is less likely but still possible

Noninflammatory to moderately inflammatory fluid: Consider a broad differential diagnosis from OA to RA. However, septic arthritis is less likely but still possible

Noninflammatory to moderately inflammatory fluid: Consider a broad differential diagnosis from OA to RA. However, septic arthritis is less likely but still possible

Synovial fluid WBC
50,000 WBC/mm3

Synovial fluid WBC
50,000 WBC/mm3

Synovial fluid WBC
50,000 WBC/mm3


3

Positive

Positive

Positive

Negative

Negative

Negative

Inflammatory arthritis not due to crystals

Inflammatory arthritis not due to crystals

Inflammatory arthritis not due to crystals

Gout or pseudogout at least

Gout or pseudogout at least

Gout or pseudogout at least

Crystals?
Under polarized light

Crystals?
Under polarized light

Crystals?
Under polarized light


Positive

Positive

Positive

Negative

Negative

Negative

Crystal-induced arthritis defined by the nature of the crystals

Crystal-induced arthritis defined by the nature of the crystals

Crystal-induced arthritis defined by the nature of the crystals

Septic arthritis

Septic arthritis

Septic arthritis

Gram stain and/or culture positive?

Gram stain and/or culture positive?

Gram stain and/or culture positive?

Positive

Positive

Positive

Negative

Negative

Negative

End

End

End

Markedly inflammatory fluid not due to crystals or infection: Consider the other possibilities of pseudoseptic arthritis

Markedly inflammatory fluid not due to crystals or infection: Consider the other possibilities of pseudoseptic arthritis

Markedly inflammatory fluid not due to crystals or infection: Consider the other possibilities of pseudoseptic arthritis

Gram stain and/or culture positive?

Gram stain and/or culture positive?

Gram stain and/or culture positive?

Positive

Positive

Positive

Negative

Negative

Negative