58-year-old male with left lower extremity erythema and warmth with elevated CRP, evaluate for abscess or osteomyelitis. Multiple foci of signal void within the soft tissues presumably correspond to surgical staples seen on prior radiographs. Review of previous imaging studies reveals a history of chronic lymphedema, and there is generalized subcutaneous edema within the soft tissues of the knee and ankle. There is a paucity of subcutaneous fat between the knee and ankle, which is presumably due to prior surgery. There is generalized thickening and enhancement of the skin consistent with cellulitis. There is also reticular enhancement of the subcutaneous fat of the knee and ankle consistent with cellulitis. There is diffuse enhancement musculature of the leg with relative sparing of the flexor hallucis longus likely reflecting additional inflammation. There is also fatty infiltration of much of the musculature of the leg. Although we see no discrete abscess, within and along the posterior aspect of the tibialis anterior muscle is a poorly defined thin elongated collection of nonenhancing tissue which could represent a phlegmon or developing abscess. Marrow signal intensity is within normal limits without evidence of osteomyelitis.
1.Findings consistent with lymphedema and postoperative changes as described above.2.Findings consistent with severe cellulitis as described above.3.Muscular inflammation as described above. Although there is no discrete abscess, poorly defined non-enhancing tissue along the posterior aspect of the tibialis anterior could represent a phlegmon or developing abscess. Although no soft tissue gas is evident on yesterday's CT scan, we cannot exclude the possibility of a necrotizing infection.4.No evidence of osteomyelitis.