Reason: history of renal transplant concern for infection, previous MRI with findings concerning for left clavicle osteomyelitis, please include this in views to evaluate for osteomyelitis. LUNGS AND PLEURA: Moderate to large bilateral pleural effusions, not significantly changed with adjacent compressive atelectasis. MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No mediastinal lymphadenopathy identified.CHEST WALL AND SOFT TISSUES: There is redemonstration of edema/fluid signal as well as increased enhancement within the fascial planes of the left upper chest wall surrounding the proximal and middle third of the left clavicle which is compatible with an inflammatory process such as cellulitis. There is also abnormal bone marrow signal, frank cortical disruption, and increased enhancement involving the proximal and to a lesser extent middle third of the left clavicle which is compatible with osteomyelitis which has progressed. This abnormal marrow signal extends to the sternoclavicular articulation with significant inflammatory change about the joint and cortical disruption of the sternum. No bony sequestrum or definite vascular involvement is visualized. T3 hemangioma.There is redemonstration of a nonspecific T2 hyperintense nodule in the subcutaneous soft tissues of the left upper back.UPPER ABDOMEN: PEG tube in place.
1.Findings compatible with increasing cellulitis and osteomyelitis of the proximal clavicle and adjacent sternum. There is involvement of the sternoclavicular articulation, concerning for septic arthritis.2.Large bilateral pleural effusions, grossly unchanged.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.