Male, 46 years old. Evaluate for large abscess or other issue on R leg soft tissues and foot. Swelling. No DVT. Foot wound. RIGHT LEG:There is circumferential subcutaneous soft tissue edema involving the entire length of the leg, compatible with cellulitis. No discrete fluid collection is identified in the soft tissues to suggest an abscess. There is also mild edema predominantly involving the anterior and the posterior compartment muscles of the leg extending toward the ankle. The underlying bones have normal cortical thickness and marrow signal abnormality.RIGHT FOOT:There is extensive subcutaneous soft tissue edema and inflammation about the forefoot. Deep skin/soft tissue ulceration is noted along the plantar aspect of the fifth toe. Susceptibility artifact in the soft tissues around the remaining great toe, compatible with postsurgical changes related to amputation, with adjacent shallow skin/soft tissue ulceration. An approximately 1 cm soft tissue collection along the plantar soft tissues of the first metatarsal without discrete fluid signal may reflect a small mature abscess. Adjacent punctate foci of fluid signal with peripheral enhancement are compatible with additional small foci of infection/developing abscesses adjacent to the first and second digits.Only the proximal portion of the fifth metatarsal remains, and there is progressive extensive cortical destruction and abnormal marrow signal within this metatarsal, compatible with osteomyelitis. The proximal phalanx is not present, and there is additional signal abnormality in the area of the proximal portion of the middle phalanx, compatible with additional area of osteomyelitis. The distal phalanx appears intact.There are postsurgical changes of disarticulation and amputation at the first metatarsophalangeal joint. There is mild increased STIR signal along the distal aspect of the first metatarsal, with only minimal abnormal T1 signal and no significant enhancement on postcontrast images, compatible with residual osteomyelitis, improved from the prior MR exam. The remainder of the bones of the forefoot/midfoot show normal cortical thickness and marrow signal.
1.Persistent osteomyelitis and progressive destruction of the fifth metatarsal. Improvement in osteomyelitis of the first metatarsal.2.Skin ulceration adjacent to the first and fifth metatarsals with extensive cellulitis of the forefoot and probable developing small abscesses adjacent to the first and second metatarsals.3.Cellulitis and nonspecific muscle edema involving the leg, without abscess or osteomyelitis. 