46-year-old male presents with a left lower extremity chronic wound, evaluate for osteomyelitis. There is ulceration of the lateral soft tissues of the lower leg just above the ankle. The underlying subcutaneous fat is replaced with abnormal signal intensity and enhancement likely representing a combination of edema and scarring. The abnormal enhancement extends to the cortex of the distal fibula. There is circumferential chronic appearing thick periosteal new bone formation likely reflecting sequela of prior infection. There is mild increased signal intensity of the distal fibula on the fat-suppressed T2-weighted images with mild enhancement of the marrow following contrast administration. However, normal fatty signal intensity of the distal fibula is preserved on the T1-weighted images. Therefore, these findings are more suggestive of a combination of prior infection and reactive osteitis rather than acute osteomyelitis. Signal intensity of the proximal fibula and tibia are normal.Severe fatty atrophy of multiple muscles of the leg. There is mild edema type signal intensity affecting other muscles that may reflect a relatively subacute phase of atrophy. Bandlike low signal intensity extending along several of the muscles likely reflects scarring. No intra or intramuscular fluid collection to indicate an abscess.
Soft tissue ulceration with findings suggesting prior infection of the fibula and reactive osteitis, but preservation of normal fatty signal intensity on T1-weighted images argues against acute osteomyelitis. Other findings as described above.