Reason: 19-year-old male with history of NK/T-Cell lymphoma s/p transplant with recurrent osteomyelitis now with bilateral foot pain History: 19-year-old male with history of NK/T-Cell lymphoma s/p transplant with recurrent osteomyelitis now with bilateral foot pain There is perhaps soft tissue irregularity along the medial and lateral aspects of the ankle which may represent ulceration. There is nonspecific enhancing subcutaneous edema most pronounced along the lateral aspect of the ankle which may represent a cellulitis in the correct clinical context. There is no evidence to suggest osteomyelitis of the underlying bone. Note is made of multiple serpentine foci of signal abnormality within the distal tibia, calcaneus, talus, navicular, cuboid, second cuneiform, and base of the fourth metatarsal consistent with osteonecrosis/bone infarcts. No osteochondral defects are identified. There is nonspecific diffuse edema affecting the imaged musculature of the ankle and foot involving both the flexor and extensor compartments. While these findings are nonspecific they may represent a myositis. There is a focus of susceptibility artifact within the subcutaneous plantar soft tissues along the plantar aspect of the cuboid which may represent a metallic foreign body (image 24; series 501). There is subcutaneous edema in the surrounding area which is nonspecific but may be inflammatory in etiology. The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact.
1. Extensive bone infarcts affecting the left ankle and midfoot as described above. There is no evidence of osteomyelitis.2. There is diffuse edema within the imaged musculature of the ankle and foot which is nonspecific but may represent a myositis.3. Soft tissue ulceration and subcutaneous edema may reflect a cellulitis in the correct clinical context, however, no focal fluid collection is seen to suggest abscess formation.4. Focus of metallic susceptibility artifact within the subcutaneous tissue along the plantar aspect of the midfoot may represent a foreign body.