Female 84 years old with swelling, pain, pus right second toe. Evaluate for osteomyelitis. There is abnormal signal intensity replacing the subcutaneous soft tissues about the distal phalanx of the second toe. The distal phalanx is replaced with high T2 signal on the fat-suppressed T2-weighted images. Although there is relatively mild signal abnormality within the distal phalanx on the sagittal T1 weighted images, abnormal low signal intensity within the tuft on the long axis sequences as well as more diffusely on the short axis T1 sequence is suggestive of osteomyelitis, particularly in light of the cortical irregularity seen on recent radiographs. There is mild enhancement of soft tissues of second toe suggesting inflammation. There are also small foci of signal void within the subcutaneous soft tissues dorsal to the proximal phalanx that may represent foci of gas, but this is equivocal. The distal phalanx of the fourth toe is abnormally small and there is increased signal within the remaining base of the distal phalanx on the fat-suppressed T2-weighted images with preservation of fat signal intensity on T1-weighted images. These findings are more suggestive of reactive osteitis than acute osteomyelitis but radiographs of the toe may be obtained for further evaluation.Mild enhancement of the soft tissues adjacent to the fifth metatarsal head likely represents a soft tissue callus.Mild osteoarthritis affects the first metatarsophalangeal joint and moderate to severe osteoarthritis affects the midfoot articulations. There is fatty atrophy of the musculature.
1.Findings suggestive of osteomyelitis of the distal phalanx of the second toe.2.Abnormality of the distal phalanx of the fourth toe may reflect sequela of prior surgery or chronic erosion but radiographs may be considered for further evaluation to evaluate for osteomyelitis.