Reason: eval for osteomyelitis in patient with chronic ulcer and xray concerning for osteo History: see above There is diffuse thickening of the skin of the ankle particularly medially, laterally, and anteriorly with mild enhancement following contrast administration. There is ulceration of the skin both medially and laterally. Heterogeneous intermediate low signal intensity of the underlying subcutaneous fat likely represents a combination of scarring and calcification. We see no fluid collection to suggest abscess and we see no abnormal signal intensity within the bone to suggest osteomyelitis. There is chronic periosteal bone formation along the distal tibia and fibula as seen on recent radiographs. There is ankylosis of the syndesmosis of the distal tibia and fibula. There is also a large bony excrescence projecting posteriorly from the medial malleolus. Mild osteoarthritis affect the ankle and midfoot. There is diffuse muscular atrophy but the visualized tendons appear normal for age. This study was not protocoled for detailed evaluation of the ankle ligaments.
Ulceration and other findings as described above without evidence of osteomyelitis.