68 year-old female. MDS and right leg skin rash concerning for leukemia cutis. She now has blistering, swelling, and exquisite tenderness to palpation concerning for superimposed NSTI or abscess. There is thickening of the skin along the dorsum of the foot. There is also extensive edema-type signal in the subcutaneous fat of the dorsum of the foot extending into the toes. This edema becomes confluent dorsal to the metatarsals and the visualized bones of the midfoot. While this confluent edema does not enhance following contrast administration and although we see no discrete rim enhancement, the possibility of a phlegmon or a developing abscess is a consideration. This collection appears to extend to the skin surface dorsal to the middle cuneiform. Overall, this collection measures approximately 1.5 cm in depth, 9 cm in length (extending off the field of view proximally), and 7 cm in the mediolateral dimension. There is enhancement of the subcutaneous fat surrounding this collection indicating inflammation. The extensor tendons lie deep to this collection and we see no specific findings to suggest extensor tenosynovitis. There is edema of the plantar musculature of the foot that does not appear to enhance following gadolinium administration. There is slight tenosynovial enhancement of the flexor hallucis longus tendon at the knot of Henry, which is of questionable current clinical significance. The bone marrow signal intensity is within normal limits.
Inflammatory changes of the forefoot, as described above, particularly affecting the dorsum of the forefoot where there is a nonenhancing collection that may either represent extensive confluent edema or a phlegmon/developing abscess; however we see no well-defined rim enhancing abscess at this time. We also cannot exclude the possibility of a superficial necrotizing infection on the basis of this exam.Findings were communicated to clinical service Dr. Parker, over the phone at time of dictation. 