History of intraosseous catheter placement complicated by osteomyelitis and septic arthritis. Now with persistently elevated ESR, pain at right knee at prior IO catheter site. Please evaluate for recurrent/persistent infection. MRI images of the right tibia/fibula and knee again show branching signal abnormality and enhancement within the proximal tibia extending from the tibial plateau into the proximal diaphysis over a craniocaudal distance of approximately 11 cm compatible with osteomyelitis. There now appears to be a more confluent area of decreased T1 signal within the proximal tibial metadiaphysis with adjacent new destruction of the anterior tibial cortex with overlying enhancing soft tissue thickening. No discrete drainable fluid collection is identified. Also again seen is less well defined signal abnormality within the distal tibia along with small foci of enhancement which also may represent infection.There is a small amount of fluid within the knee, however, no effusion; septic arthritis cannot be excluded on this examination.Although this examination was not protocoled to evaluate for internal derangement of the knee, the cruciate ligaments and menisci appear grossly intact.
Residual osteomyelitis which appears progressed from the prior examination with new cortical destruction.