Reason: eval extent of infection including ankle/hindfoot/midfoot/forefoot History: left foot wound Left midfoot/forefoot:Extensive signal void related to multiple foci of gas within the subcutaneous and soft tissue tissues along the plantar and dorsal aspect of the midfoot and forefoot limits evaluation of the underlying bone marrow signal, particularly along the second and third digits of the foot. There is apparent increased signal abnormality within the proximal phalanx of the second digit on fluid sensitive sequences which demonstrates decreased signal abnormality on T1-weighted images, suspicious for osteomyelitis, although evaluation is limited secondary to patient motion artifact. No focal fluid collection is identified to suggest abscess formation. There is increased signal abnormality within the imaged musculature of the foot on fluid sensitive sequences as well as nonspecific diffuse subcutaneous edema.Left ankle/midfoot:No bone marrow signal abnormalities are identified within the bones of the ankle or midfoot to suggest osteomyelitis. There is no frank osteolysis or cortical destruction identified. There is increased signal abnormality within the navicular bone about the talonavicular articulation, likely degenerative in etiology. There is increased signal abnormality and fluid sensitive sequences within the plantar musculature of the left foot. Again seen are numerous foci of signal void within the subcutaneous and soft tissues along the plantar and dorsal aspect of the left foot corresponding to gas seen on recent radiographs, extending from the level of the plantar aspect of the calcaneus to the level of the distal tufts of the seconds and third phalanges. No focal fluid collection is identified to suggest abscess formation.
1. There is signal abnormality within the proximal phalanx of the second digit which is suspicious for osteomyelitis, particularly if there is skin ulceration in the surrounding area, although evaluation is limited secondary to patient motion artifact and extensive gas within the surrounding area. 2. Nonspecific subcutaneous and soft tissue edema with extensive gas intensity along the plantar and dorsal aspect of the foot consistent with the findings seen on recent radiographs. A necrotizing infection/fasciitis cannot be excluded by this examination. No evidence of abscess formation.