Proximal tibia pain, fever, leukocytosis, elevated ESR/CRP, assess for progression of osteomyelitis Worsening osseous T1 hypointensity signal involving the proximal tibial epiphysis, metaphysis, and diaphysis, with improvement on the the proximal fibular proximal epiphysis and metaphysis. There is also worsening of the associated T2 hyperintensity in these regions. The cortex of the proximal tibial laterally, appears to be disrupted with a subperiosteal fluid collection and peripheral enhancement after administration of contrast (arrows on image 9 on series 2 and image 16 on series 9). These findings are compatible with subperiosteal abscess. There is an increase in right knee joint effusion with associated enhancement of the synovium after administration of contrast rising the possibility of septic joint. More extensive cellulitis and myositis of the right lower leg is noted. Nonspecific bone marrow changes of the proximal third of the tibial diaphysis with lack of contrast-enhancement, may represent early development of intramedullary abscess.
Worsening osteomyelitis with development of subperiosteal abscess of the proximal metaphyses of the right tibia. Right knee septic joint. Worsening in the extension of the cellulitis and myositis.