64-year-old male with a history of mycobacterium infection in the right wrist now clinically worse with increased edema, erythema, reevaluate infection. Presents with right wrist pain. Evaluation is limited due to the small area of coverage as well as poor fat suppression on the fluid sensitive sequences and poor T1 weighting. Again seen is an enhancing intramedullary mass in the distal ulna extending from the articular surface into the distal diaphysis, off of the field of view of this study, compatible with the stated history of mycobacterium infection. The infection extends through the volar cortex of the distal end of the ulna into the soft tissues forming a collection volar to the ulnar margin of the pronator quadratus. Additional foci of cortical penetration and soft tissue extension are noted both volarly and dorsally along the distal ulnar metadiaphysis. Please note that the proximal extent of this lesion is not included on the field-of-view of this study. There is additional enhancement and edema of the soft tissues surrounding the ulna, indicating inflammation. There is mild enhancement of the distal radioulnar and radiocarpal articulations indicating synovitis. Please note that we cannot exclude the possibility of a septic arthritis. There is mild enhancement of the radial styloid which may represent infection or reactive edema. There is enhancement within the medial margin of the triquetrum which may represent an erosion, although this was present on the prior study. There also appears to be mild enhancement of the midcarpal joint. Also again seen is abnormal signal intensity within the base of the third metacarpal, however, on the current study we see this signal abnormality and enhancement extend into the distal diaphysis of the third metacarpal where it penetrates the volar and medial cortex, extending into the soft tissues between the third and fourth metacarpals and deep to the flexor tendons of the middle finger.
1. Osteomyelitis of the distal ulna with extension into the surrounding soft tissues.2. Osteomyelitis of the third metacarpal with extension into the soft tissues between the third and fourth metacarpals deep to the flexor tendons of the third finger.3. Please note that the full extent of the infection is not included on the field-of-view on this study. The patient may return for additional imaging of the forearm and hand if clinically warranted.