Reason: evaluate for osteomyelitis in the setting of normal plain film History: chronic non-healing ulcer, PAD, malodorous drainage, elevated ESR/CRP, elevated WBC There is ulceration of the soft tissues anteromedial to the distal tibial metadiaphysis. There is also skin thickening as well as reticulation of the subcutaneous fat indicating edema. There is mild periosteal edema along the medial aspect of the distal tibia which likely corresponds to periosteal reaction seen on the recent radiographs, but we see no abnormal signal or enhancement in the underlying bone to confirm osteomyelitis. We see no rim-enhancing fluid collection to indicate abscess. There is a small amount of fluid in the tibiotalar and subtalar joints which is within normal limits. Osteoarthritis affects the midfoot.
Soft tissue swelling and ulceration with mild periosteal edema along the distal tibia which may be reactive in etiology. We see no abnormal medullary signal to confirm osteomyelitis.