16-year-old male with history of redness and warmth in the right lower extremity. Evaluate for osteomyelitis or joint effusion. There is high T2 signal diffusely within the right lower leg musculature. There is generalized atrophy of the musculature as well. There are also mild inflammatory changes within the subcutaneous fat. These areas also demonstrate mild enhancement after contrast administration. No evidence of drainable fluid collections. The underlying tibia and fibula are normal. There is no knee joint effusion.There is a small right hip joint effusion. Development of dysplasia of the right hip again noted. Once again, marked atrophy and increased T2 signal present within the upper leg musculature. There is a postoperative longitudinally oriented high T2 linear defect within the right lateral thigh with adjacent foci of susceptibility likely representing gas density. This tract extends to the lateral mid femur surface. Mild heterogeneous enhancement is appreciated within the tract. There is chronic periosteal reaction about the mid femur however the underlying bone marrow signal intensity appears normal with no evidence of acute osteomyelitis. Skin thickening with moderate enhancement of the subcutaneous tissues of the thigh.Fluid filled rectum. The right testes is located within the inguinal canal. Left hip dysplasia.
1. Postoperative changes in the right thigh of hardware removal with a residual thin fluid filled tract extending to the femur surface. This likely represents a combination of granulation tissue and fluid, however given the presence of gas density, an infected tract is favored. While there is chronic periosteal reaction of the femur in this area, the underlying bone signal abnormality is normal with no evidence of acute osteomyelitis.2. Skin thickening and inflammation of the subcutaneous fat of the lateral right femur likely represents a cellulitis.3. Diffuse muscular atrophy of the upper and lower legs with increased T2 signal abnormality which is likely the result of denervation.4. Small right hip joint effusion.5. Right testis is located within the inguinal canal.6. Fluid filled sigmoid and rectum.