35 year old male with chronic right lower extremity wounds and lymphedema. Evaluate for osteomyelitis. Please note that due to the patient's body habitus, the soft tissues of the leg are not included in their entirety. Right tibia/fibula:There is thickening of the skin and reticulation of the subcutaneous fat compatible with the stated history of lymphedema. Within the anterior subcutaneous fat of the leg, approximately 15 cm proximal to the tibiotalar joint, is an irregular crescentic collection of fluid signal intensity, measuring approximately 5.5 x 1.5 x 4.5 cm (TR x AP x CC) with thin rim enhancement, which presumably corresponds to the fluid collection seen on ultrasound examination performed earlier today. There are small foci of internal low signal intensity which could represent calcification or gas. We see no definite communication with the overlying skin surface. Distal to this collection, the edema becomes more confluent, but we see no additional rim enhancing fluid collections. There is fatty atrophy of the musculature of the leg, particularly affecting the gastrocnemius, soleus, and peroneal musculature. There is mild edema type signal within these muscle groups as well, which may simply reflect underlying atrophy. We see no evidence to suggest intramuscular abscess formation. We see no signal abnormality within the tibia or fibula to indicate osteomyelitis.Right foot:There is reticulation of the subcutaneous fat, particularly dorsally and medially, compatible with the stated history of lymphedema. Although the edema becomes confluent, we see no fluid collection to suggest abscess formation. There is increased signal intensity within the plantar musculature of the foot which may reflect underlying atrophy. There is a small amount of fluid within the flexor hallucis longus tendon sheath, near the knot of Henry, which is nonspecific. There are small subcentimeter lobulated fluid collections adjacent to the tendon sheath with minimal if any enhancement, which may represent ganglia. We see no findings to suggest osteomyelitis.
1. Lymphedema of the right leg and foot.2. Irregular fluid collection within the anterior subcutaneous fat of the lower leg with thin peripheral enhancement corresponding to that seen on the ultrasound examination performed earlier today which could represent an abscess, but please correlate with physical examination for wounds at this location.3. No findings to suggest osteomyelitis.