56-year-old man with fever of unknown origin. The patient is status post great toe amputation. Evaluate for osteomyelitis or other infection. Examination is limited due to motion artifact on some sequences. As seen on prior radiographs from 11/1/2016, the patient has undergone an amputation of the first ray through the mid-diaphysis of the first metatarsal. There is a fluid collection in the soft tissues distal to the remaining first metatarsal, measuring approximately 2 x 2 cm in transverse dimension, and approximately 4 cm in longitudinal dimension. The collection extends toward but does not definitively contact a linear defect in the skin dorsally, that presumably represents a surgical incision. The fluid collection contacts the surgical margin of the first metatarsal. There is mild edema-type signal within the bone adjacent to the surgical margin on the fat-suppressed T2-weighted sequences, but marrow signal intensity appears relatively normal on the T1-weighted images. Signal intensity of the remaining bones of the forefoot is normal. There is relatively mild edema in the surrounding soft tissues. Small foci of low signal intensity within the collection are nonspecific, and may represent gas.
Postoperative changes of first ray amputation through the mid-diaphysis of the first metatarsal. There is a fluid collection abutting the surgical margins of the bone that is nonspecific and could represent a seroma or an abscess. Relatively mild signal abnormality in the adjacent bone favors reactive osteitis, although we cannot entirely exclude the possibility of early osteomyelitis.