Reason: assess for osteomyelitis History: skin infection, elevated CRP, immunosuppressed Right femur:There is a small amount of fluid within the right hip without evidence of a large effusion. There is no bone marrow signal abnormality within the right femur to suggest osteomyelitis. There is diffuse nonspecific subcutaneous edema about the right hip and thigh. There is fatty atrophy of the musculature of the thigh most pronounced within the posterior compartment musculature. There is also enhancing increased signal abnormality within the hamstring musculature which is nonspecific but may reflect a myositis. Although the edema becomes confluent along the posterior and lateral aspect of the distal femur no focal encapsulated fluid collection is identified to suggest abscess formation. Note is made of a large knee joint effusion with thickened enhancing synovium indicating a synovitis.Right tibia/fibula:Severe osteoarthritis affects the right knee. Again seen is the right knee joint effusion with foci of internal debris and synovial enhancement on postcontrast sequences indicating a synovitis. There is a lobulated focus of fluid signal intensity within the proximal fibula likely representing a benign enchondroma, although this could be further evaluated with dedicated radiographs. There is nonspecific enhancing subcutaneous edema along the anterior and medial aspect of the leg. There is associated skin thickening most pronounced along the anterior aspect of the leg. There is soft tissue irregularity in this area which may represent ulceration. There is no bone marrow signal abnormality in the surrounding area to suggest osteomyelitis. There is diffuse fatty atrophy of the imaged musculature of the right leg. There is no focal fluid collection to suggest abscess formation. There is mild increased signal abnormality and fluid sensitive sequences within the anterior tibialis muscle which may reflect a myositis.
1. Extensive nonspecific enhancing subcutaneous edema about the thigh and leg as described above consistent with the stated history of a cellulitis. There is also signal abnormality within the hamstring musculature and anterior tibialis muscle which may reflect a myositis. There is no bone marrow signal abnormality to suggest osteomyelitis. There is no focal fluid collection to suggest abscess formation.2. Note is made of large bilateral knee joint effusions with thick enhancing synovium indicating a synovitis.3. Lobulated lesion within the proximal right fibula may represent a benign enchondroma, however, this could be further evaluated with dedicated radiographs if clinically warranted.4. Osteoarthritis of the knees and other findings as described above.