16-week-old male with left septic hip arthritis and abscesses status post incision and drainage. Evaluate for osteomyelitis/septic hip/soft tissue abscess. The left femoral metaphysis is displaced anteriorly and laterally to the femoral epiphysis and acetabulum similar to prior. Moderate-sized intermediate T1 and intermediate T2 signal intensity joint effusion with synovial enhancement decreased in size from prior exam. New small T2 hyperintense/T1 hypointense joint effusion in the right hip with associated synovial enhancement.Focal increased T2 signal in the distal left femoral metaphysis is unchanged from prior study with no associated enhancement or bone destruction. Mild subperiosteal T2 hyperintensity and enhancement along the femoral metaphyses, left greater than right, appear more prominent and well-defined compared to prior exam. The precontrast sequences of this area demonstrate normal marrow T1 signal with no bone destruction. Again seen is moderate T2/STIR signal within the left gluteal and left thigh musculature with associated enhancement. The previously referenced collections/abscesses in the gluteal and proximal thigh musculature are no longer visualized. There are new two linear T2 hyperintensity/T1 hypointense nonenhancing tracts coursing through the left anterior and lateral soft tissues to the hip joint most compatible with tracks related to recent incision and drainage procedure. A drain enters the lateral tract and terminates adjacent to the proximal femur. Also present in the soft tissues/musculature about the right hip and thigh however to a lesser degree compared to the left is T2/STIR hyperintense induration without appreciable enhancement. Similar signal intensity pattern is also present along the fascial planes.
1. Extensive edema and inflammation in the left gluteal and thigh soft tissue/musculature with interval resolution of the previously identified abscesses. New moderate edema and inflammatory changes in the right gluteal and thigh soft tissues/musculature.2. Decreasing size of moderate left hip joint effusion with associated synovitis and displacement of the left femoral metaphysis. New small right hip joint effusion with associated synovitis. 3. Bilateral subperiosteal edema and enhancement along the femoral metaphyses, left greater than right, with no evidence of osteomyelitis. 