48-year-old male with right hand edema, erythema, pain despite being on clindamycin. Rule out osteomyelitis or abscess. There is decreased T1 and increased T2 signal abnormality affecting the entire second and third metacarpals as well as the base of the fourth metacarpal with enhancement on postcontrast sequences, consistent with osteomyelitis. There is also decreased T1 and increased T2 signal abnormality affecting all of the carpal bones and distal radius with associated enhancement, also suspicious for osteomyelitis.There is extensive diffuse edema type signal abnormality most pronounced along the dorsal aspect of the hand which extends anteriorly. There is diffuse increased signal abnormality within the musculature of the hand concerning for myositis. There is a focal fluid collection with associated peripheral enhancement on postcontrast sequences within the soft tissues along the dorsal aspect of the first carpometacarpal joint which is difficult to measure but is approximately 5.1 x 0.9 cm and is suspicious for abscess formation (7; series 16). There is an additional focus of heterogeneous increased T2 signal abnormality with peripheral enhancement in the soft tissues along the dorsal aspect of the distal ulna which measures 1.9 x 0.7 cm (22; series 16) which is suspicious for phlegmon or early abscess formation. An additional subcentimeter focal fluid collection along the dorsal aspect of the distal ulna with peripheral enhancement is also suspicious for abscess formation (19; series 16). The findings can be confirmed with ultrasound examination if considering drainage.
Findings consistent with extensive subcutaneous edema and osteomyelitis of the hand and wrist. There are multiple focal fluid collections about the wrist which are suspicious for abscess formation, as described above.