A 39-year-old male presents to the ED with a swollen left ankle.  He states he was bit by his cat two days ago and has noted progressive pain and redness.  On examination, the patient is febrile at 38.4 C and his exam reveals extensive erythema over the ankle with several puncture wounds noted medially.  You consult the ortho service due to your concern that the patient has more than a simple cellulitis.  The ortho resident tells you this is "just a cellulitis" and tells you to admit the patient to medicine.  You perform a bedside ultrasound and note the following...

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