A 51-year-old woman is sent from urgent care to the emergency department with pain in the left elbow that has gradually worsened over the past 12 hours. She denies injury, fever, or other symptoms and has never experienced pain in her elbow previously.

The patient is afebrile and vital signs are normal. Severe pain is noted with elbow flexion, but no swelling is identified. The area of the olecranon is quite tender and slightly warm. No appreciable redness or fluid collection is noted. Complete blood cell count is normal. Soft tissue ultrasound is normal with no evidence of joint effusion. Radiograph of the left elbow is obtained (Figure).

Initial diagnostic considerations include infection, pseudogout, or trauma without recall.

Upon close examination, what does the radiograph show?

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This article originally appeared on Clinical Advisor