13-year-old male with history of edema/erythema of the ankle and limited range of motion. Evaluate for inflammatory changes, osteomyelitis. Femur:Limited evaluation of the femur/thigh was performed due to patient's intolerance of the exam length. Edema type signal intensity is seen circumferentially within the subcutaneous fat, extending from the right hip inferiorly beyond the femur. Small amounts of edema type signal intensity is seen within the distal thigh musculature. No soft tissue gas is seen. The femora are grossly normal in morphology and signal intensity. Small knee joint effusion partially visualized. Tib-fib:Edema type signal intensity is seen circumferentially within the subcutaneous fat about the right knee, and extends distally through the level of the ankle. Additionally, abnormal high T2 signal intensity is seen within the deeper musculature about the knee and calf. Some of this edema is confluent, layering between/within the fascial planes of the deep musculature of the thigh. No soft tissue gas is seen. Abnormal bone marrow signal intensity is seen within the tibia, particularly at the proximal and distal metaphyses. Abnormally high, heterogeneous T2 signal intensity within the proximal tibial metaphysis extends from the physis distally approximately 11 cm (series 14 image 13). Abnormal signal, heterogeneous T2 signal intensity within the distal tibia metaphysis extends from the distal physis proximally approximately 9.7 cm. An additional focus of abnormal high T2 signal intensity is seen within the right tibia diaphysis (14/15) and measures approximately 3.9 x 0.6 cm, which could represent an early abscess.Overlying the posterior medial distal tibia metaphysis (22/31 and 22/32) is a loculated fluid signal intensity collection which tracks centrally from the level of the distal tibial physis over an length of approximately 3.5 cm. These loculations measure 1.3 x 0.7 and 1.2 x 0.7 cm in the axial plane. Foot:Edema type signal intensity is noted within the subcutaneous soft tissues of the foot, particularly dorsally. Additional abnormal high signal intensity is seen within the deeper compartments of the foot as well, and some of this edema is confluent. No soft tissue gas is seen. Bone marrow signal intensity of the tarsals, metatarsals and toes is within normal limits.
1.Cellulitis of the right lower extremity as above.2.Deep fascial/muscular edema and fluid from the distal thigh through the foot, suggesting fasciitis particularly in the appropriate clinical setting.3.Abnormal bone marrow signal intensity of the tibia as above, suggesting osteomyelitis.4.Small loculated fluid collection adjacent to the distal posterior medial tibia metaphysis likely to represent subperiosteal abscess. The abnormal signal within the mid diaphysis of the tibia may represent developing abscess. These findings were discussed with Dr. Bielski at the time of dictation.