29-year-old male with purulent drainage, cellulitis and tenderness particularly at the second MCP joint. Evaluate for osteomyelitis. There is subcutaneous edema about the midfoot and forefoot most pronounced along the dorsal aspect of the metatarsals. There is soft tissue irregularity along the dorsal aspect of the fourth metatarsal head consistent with ulceration which extends to the level of the extensor tendon at the level of the fourth MCP joint. There is increased signal abnormality on fluid sensitive sequences in the surrounding area which presumably represents a combination of packing material and granulation tissue. There is rounded fluid signal intensity in the surrounding area, dorsal to the fourth metatarsal head which is suspicious for a small abscess, measuring 13 mm in its largest dimension. There are foci of fluid signal intensity within the interspaces between the first and second digit as well as between the second and third digit, which may represent confluent edema, although a bursitis could also be considered. There is increased signal abnormality within the base of the proximal phalanx of the fourth digit on fluid sensitive sequences without associated decreased signal abnormality on T1-weighted sequences. These findings are most consistent with reactive osteitis. There is no convincing evidence of osteomyelitis as clinically questioned.
Extensive subcutaneous and soft tissue edema about the midfoot and forefoot consistent with the stated history of ulceration with associated cellulitis. Signal abnormality within the base of the proximal phalanx of the fourth toe appears most consistent with reactive osteitis. There is no convincing evidence of osteomyelitis. There is a small 13 mm fluid collection along the dorsal aspect of the fourth metatarsal head suspicious for abscess formation. No large drainable collection is identified.