18-year-old boy with history of gunshot wound and swelling, evaluate for osteomyelitis. BONES: There is abnormal T1 and STIR signal involving the first metatarsal diaphysis with loss of the normal cortex along the dorsal and plantar aspects (series 601, image 27; series 401, image 11). Additionally, this area enhances indicating active inflammation.There is also abnormal T1 and STIR signal with enhancement involving the base of the second metatarsal (series 701, image 31; series 1101, image 32) and the middle cuneiform (series 701, image 37; series 1101, image 38). No cortical destruction is identified.SOFT TISSUES: Abnormal decreased T1 and increased signal is seen extending from these areas of cortical loss to the skin on both the dorsal and plantar surfaces of the foot. There is a small amount of fluid tracking along the medial aspect of the second metatarsal base (series 701, image 28) but no discrete, drainable fluid collection is identified. The muscles and tendons of the foot appear normal.
Osteomyelitis involving the first metatarsal diaphysis with extension into the second metatarsal base and middle cuneiform.