Cellulitis and abscess There is a large soft tissue defect along the posteromedial aspect of the lower leg which appears continuous with a nonenhancing collection in the underlying subcutaneous fat which tracks laterally along the posterior margin of the soleus. At this level, the collection measures 5.5 x 2 cm, demonstrates rim enhancement, and tracks superiorly between the soleus and medial head of the gastrocnemius into the proximal calf where there is edema of the adjacent posterior calf musculature. The collection also extends distally, disrupting the fibers of the Achilles tendon, where it communicates with a second skin defect approximately 4 to 5 cm above the calcaneus. The total craniocaudal extent of this collection measures approximately 25 cm.Intermediate signal intensity material overlying the above-mentioned skin wounds likely reflects packing material. There is a small collection of nonenhancing fluid deep to the soleus which we suspect is reactive in nature. There is deformity of the tibial and fibular diaphyses indicating prior trauma and orthopedic intervention. There is no bone marrow edema or enhancement to suggest osteomyelitis. Small foci of signal abnormality within the tibia likely reflect areas of osteonecrosis. There is mild fatty atrophy of the peroneal muscles and there is circumferential subcutaneous edema that becomes confluent lateral to the proximal tibia/fibula.
Large soft tissue defect appearing continuous with a large nonenhancing fluid collection that extends beneath the medial head of the gastrocnemius into the proximal calf and distally through the Achilles tendon. There is no evidence of osteomyelitis. Additional findings are described above.These findings were discussed with Dr. S. Catlett of the primary service at 9:35 AM.