69-year-old male with swelling of legs, chronic ulcer, suspicious findings on CT. Evaluate for osteomyelitis. There is soft tissue irregularity along the anterior aspect of the left tibia, consistent with the patient's known history of ulceration. There is diffuse nonspecific subcutaneous edema about the leg. There is associated enhancement of the subcutaneous tissues underlying the aforementioned ulceration which extends to the level of the anterior cortex of the tibial diaphysis. There is associated periosteal reaction affecting the mid diaphysis of the tibia and fibula consistent with with the findings seen on recent CT examination. These findings appear most consistent with chronic osteomyelitis. There is no bone marrow signal abnormality to suggest acute osteomyelitis. There is diffuse fatty atrophy of the imaged musculature of the leg. There is a small to moderate sized knee joint effusion which extends posteromedially into a small Baker's cyst, with associated thick nodular enhancement on postcontrast sequences suggesting a synovitis.
1. Findings consistent with ulceration and subcutaneous edema along the anterior aspect of the left leg with associated periosteal reaction that appears most consistent with chronic osteomyelitis as described above. No imaging findings to suggest acute osteomyelitis are identified.2. Small to moderate sized joint effusion with associated nodular enhancement suggesting a synovitis.