History of bilateral lower extremity ulcerations, evaluate for osteomyelitis. MR images of the right tibia/fibula are provided. Postsurgical changes of prior ACL graft are partially visualized. A skin marker is present along the medial ankle at the site of patient's soft tissue ulcer with underlying soft tissue edema and abnormally increased soft tissue enhancement. In the underlying medial tibia just proximal to the tibiotalar joint, there is loss of cortex (series 1601, image 15) with underlying bone marrow signal abnormality and increased enhancement compatible with osteomyelitis. The area of osseous signal abnormality on the T2 images measures approximately 3.0 x 1.5 cm in the axial plane. The remaining visualized bone marrow signal is grossly within normal limits. Aside from a soft tissue edema in the medial ankle, the visualized soft tissues are otherwise grossly unremarkable.MR images of the left tibia/fibula demonstrate a skin marker along the lateral aspect of the distal leg representing site of patient's soft tissue ulcer. Subjacent to the marker, there is mild soft tissue swelling and increased soft tissue enhancement without underlying cortical or bone marrow signal abnormalities to suggest osteomyelitis. The remaining bone marrow signal intensity is within normal limits. The remaining soft tissues are otherwise grossly unremarkable.
1.Findings compatible with osteomyelitis involving the medial aspect of the right distal tibia.2.No evidence of osteomyelitis in the left tibia/fibula.