 There are numerous areas of serpiginous T2 hyperintense and T1 hypointense signal with enhancement on postcontrast imaging. The most prominent abnormal area is in the proximal right tibial metadiaphysis that extends proximally into the mid epiphysis and measures 10.5 cm in craniocaudal dimension. Along the anteromedial aspect of the proximal metaphysis there is a probable subperiosteal abscess with a tract that appears to drain to the skin surface (series 11 image 10). Linear area of abnormal signal with less pronounced postcontrast enhancement within the cortex of the right tibial mid diaphysis that measures proximally 5.1 cm in craniocaudal dimension.In the distal right tibial metadiaphysis there is abnormal signal with mild enhancement that measures 7.6 cm in craniocaudal dimension. There is no definitive evidence of spread of abnormal signal to the distal epiphysis. There is a focal cortical defect in the posteromedial distal metaphysis (series 4 image 65). There is mild subcutaneous inflammation along the medial distal metaphysis without evidence of a subperiosteal abscess.
Findings compatible with osteomyelitis in the proximal right tibia with spread to the proximal epiphysis. Probable osteomyelitis in the mid diaphysis and the distal metadiaphysis.