Reason: ? Osteomyelitis History: ulcerations Right ankle:Again seen is ulceration along the anterolateral aspect of the right ankle with heterogeneity of the underlying fat, which likely represents a combination of chronic scarring and inflammation. There is enhancing increased signal abnormality within the subcutaneous tissues along the anterolateral aspect of ankle which may represent a cellulitis. There is signal abnormality of the marrow of the distal tibia/fibula as well as within the calcaneus and talus, which likely represents residual/reconverted red marrow. We see no specific findings to suggest osteomyelitis. We see no fluid collections to indicate abscess. A small focus of signal abnormality in the distal tibia may represent a cyst, unchanged. Low signal along the posterior medial ankle likely represents chronic scarring or postsurgical change. There is a small amount of fluid in the tibiotalar joint but no large effusion. Linear increased signal abnormality within the Achilles tendon suggests mild tendinosis or interstitial tearing.Left ankle:Ulceration along the medial and lateral aspects of the ankle with enhancing heterogeneity of underlying fat likely represents a combination of inflammation/cellulitis as well as chronic scarring. Again seen is bone marrow signal abnormality of the distal tibia/fibula likely represents residual/reconstituted red marrow, but we see no specific findings to suggest osteomyelitis. We see no fluid collections or abscess formation. Additional patchy signal abnormality in the bones of the foot also likely represents additional red marrow. The visualized tendons appear normal. There is atrophy of the muscles of the ankle as well as what appears to be an accessory soleus muscle.
Bilateral soft tissue ulcerations with findings suggestive of soft tissue inflammation/cellulitis as well as chronic scarring. No evidence of osteomyelitis or abscess formation. The bony sequela of sickle cell disease are again seen.