38-year-old male presents with ulceration and discoloration of the left third finger, evaluate for infection or bone necrosis. There appears to be loss of the soft tissue distal to the tuft of the distal phalanx of the middle finger. However, the distal phalanx maintains its normal predominantly fatty signal intensity on T1-weighted images and no definite edema or enhancement is seen within this bone on the fat-suppressed T2-weighted and postcontrast sequences. Increased signal intensity within the distal phalanx on certain fat suppressed images is favored to represent incomplete fat saturation. The middle and proximal phalanges of the middle finger appear normal as do the remaining visualized bones of the hand. On the single large field of view coronal T1-weighted sequence, there is abnormal low signal intensity within the lunate bone. This cannot be further characterized and may represent a cyst or avascular necrosis. It is not necessarily of any current clinical significance. There is mild subcutaneous edema dorsal to the proximal interphalangeal joint of the index finger.
Loss of soft tissue along the tuft of the distal phalanx of the middle finger, but no evidence of osteomyelitis. Additional findings as described above.The above findings were communicated via a text-page to Michael Hawking (pager 1646) at 2:23 PM on 12/1/2016.