Reason: patient with b/l knee ulcerations and zygomycetes infection. Eval for extension of infection History: above There are ulcerations affecting the soft tissues of the knee. The largest is situated just below the patella with nonenhancing near-fluid-signal-intensity extending to the inferior pole of the patella disrupting the attachment of the patellar tendon indicating a complete or near complete tear. The patella itself is slightly high riding and there is undulation of the distal quadriceps tendon. There also may be a small erosion along the inferior margin of the patella with edema within the adjacent bone, concerning for osteomyelitis. There is a thin elongated rim-enhancing collection superficial to the medial retinacular structures measuring 3.3 x 0.7 x 3.1 cm, which could represent a small abscess. This may communicate with the aforementioned large anterior ulceration, but this is equivocal. There is extensive edema within the subcutaneous fat, some of which becomes confluent. There is a moderate-sized joint effusion with thickened and enhancing synovium. This may also communicate with the aforementioned large anterior ulceration, but this is equivocal. Nonetheless, this is concerning for septic arthritis. We see no erosions within the femur or tibia. While this study was not protocoled for detailed evaluation of the articular cartilage, we see no definite articular cartilage defects. The cruciate and collateral ligaments appear intact.
1. Large anterior soft tissue ulceration associated with disruption of the proximal patellar tendon and joint effusion as well as a thin elongated rim-enhancing fluid collection along the medial retinacular structures which may communicate with this ulceration but this is equivocal.2. Edema within the patella with possible focal erosion of the inferior pole of the patella which is concerning for osteomyelitis.These findings were discussed with Dr. Bacaloa, by phone at 1:15 PM on 2/17/2016.