Reason: Eval for fluid collection, worsening cellulitis History: Unstable BP. h/o fevers while in hospital. +Pasturella cellulitis in setting of chronic venous stasis ulcer Note is made of skin thickening and diffuse subcutaneous reticulation and edema consistent with the stated history of cellulitis. This is diffuse but appears most pronounced along the lateral aspect of the leg. Additionally, there is a loculated collection of fluid signal intensity within the subcutaneous tissues along the lateral aspect of the proximal fibular metadiaphysis which demonstrates peripheral enhancement on postcontrast sequences measuring 9.2 x 3.7 x 14.9 cm (AP x TR x CC) suspicious for early evolving abscess formation. This extends to the level of the fascia of the lateral compartment musculature. There is diffuse increased signal abnormality within the musculature of the leg which is nonspecific but may suspicious for a myositis. The bone marrow signal is within normal limits without findings to suggest osteomyelitis. Although this examination was not protocoled for detailed evaluation of the knee, there appears to be at least a small left knee joint effusion with thickened enhancing synovium suggesting a synovitis, incompletely imaged on this examination.
1. Diffuse inflammatory change most pronounced along the lateral aspect of the left leg consistent with the stated history of a cellulitis which extends to the level of the underlying fascia. There is a 14.9 cm loculated enhancing fluid collection within the subcutaneous tissue along the lateral aspect of the proximal fibular metadiaphysis suspicious for early evolving abscess formation. No evidence of osteomyelitis. Follow up examination to establish resolution/evaluate for interval change is recommended. 2. Diffuse increased signal within the musculature of the leg is nonspecific but suspicious for a myositis.3. Although this examination was not protocoled for detailed evaluation of the knee, there are findings suggestive of a synovitis of the left knee as described.