Reason: r/o osteo History: osteo on Xray, pain There is confluent decreased T1-weighted and increased T2-weighted signal within the proximal and middle phalanx of the fifth toe, with overlying soft tissue defect, compatible with osteomyelitis. The pathologic fracture of the fifth proximal phalanx is better evaluated on recent radiograph. There is associated bone marrow edema within the distal phalanx of the fifth toe, as well as the fifth metatarsal head.Low T1-weighted signal associated with increased T2-weighted signal within the middle phalanx of the fourth toe is also compatible with osteomyelitis.Additionally, confluent decreased T1-weighted and increased T2-weighted signal in the distal first phalanx is compatible with osteomyelitis. There is an ulceration along the medial aspect of the great toe.No discrete fluid collections are identified in the soft tissues, however, evaluation is somewhat limited given the lack of intravenous contrast.
Osteomyelitis affects the proximal and middle phalanx of the fifth digit, the middle phalanx of the fourth digit, as well as the distal phalanx of the great toe.