28-year-old male with right lower extremity cellulitis involving the knee down, with concern for underlying osteomyelitis. Diffuse soft tissue edema about the lower extremity, with a prominent collection along the medial tibial plateau with foci of low signal intensity, likely gas, extending to the bone surface of the medial tibial plateau. There is minimal enhancement after contrast administration with no discrete rim-enhancing collection identified to suggest an abscess. There is a depressed medial tibial plateau fracture, better evaluated on subsequent CT study. There is abnormal bone marrow signal in the medial tibial plateau demonstrating low T1 and low T2 signal intensity however no findings to suggest bone marrow edema and there is no enhancement after contrast administration.There is edema type signal in the adjacent musculature. Bone marrow signal of the remaining tibia and fibula appear normal.
Diffuse soft tissue swelling with a more pronounced collection adjacent to the medial proximal tibia with soft tissue gas extending to the bone surface of the medial tibial plateau where there is a depressed fracture better evaluated on subsequent CT study. There is low T1, low T2 signal intensity of the bone marrow of the medial tibial plateau, however no evidence of bone marrow edema. Given the above findings however, osteomyelitis is not entirely excluded.