Male, 39 years old. Left BKA w/ open ulcer. The patient has undergone below-the-knee amputation through the proximal to mid left tibial diaphysis. The medial aspect of the distal end of the stump is not well seen on several sequences due to lack of signal. There is abnormal decreased signal within the distal 7 to 8 cm of the tibia with enhancement following contrast administration, compatible with osteomyelitis. The distal margin of the fibula is irregular, likely representing heterotopic bone formation. We see no edema or enhancement of the fibula to suggest osteomyelitis.There is also abnormal signal intensity and enhancement of the distal soft tissues of the stump representing inflammation. Irregularity of the margins of the distal end of the stump presumably represents ulceration. There is a small rim-enhancing fluid collection within the subcutaneous fat just lateral to the anterior tibial tuberosity which may represent bursitis. An abscess is considered less likely as we see no communication with the skin surface or with the inflammatory changes of the distal stump. There is fatty atrophy of the remaining musculature of the lower leg. The patient has also undergone below-the-knee amputation on the right as seen on the large field-of-view coronal images. We see no findings to suggest osteomyelitis on the right.
Surgical changes of below-the-knee amputation with osteomyelitis of the left tibia as described above.