Osteomyelitis, toe, MR
Claim CME CreditPOINT OF CARE INFORMATION
This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.
Learning Objectives
As a result of participation in this activity, participants should be able to:
- Provide improved patient care.
- Greater knowledge of the imaging characteristics of the patient's disease.
- Understand a better approach to interpretation of studies.
Faculty Disclosure
Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.
CME Advisory Committee Disclosure:
Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.
Continuing Medical Education Credit
Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CB1131-Osteomyelitis, toe, MR
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CB1131-Osteomyelitis, toe, MR
Case ReportHistory
Exam
Findings
Findings
Ulcer along the plantar/medial aspect of the great toe at the level of the interphalangeal joint. This extends down to the medial margin of the great toe proximal phalanx head. There is enhancing edema surrounding the ulcer compatible with cellulitis. Soft tissue gas or packing material within the ulcer tract.
Additional focal signal abnormality along the dorsal aspect of the great toe, at the level of the distal phalanx head and interphalangeal joint, measuring 2.0 x 0.7 x 1.8 cm. This extends about the dorsal aspect of the toe and surrounds a portion of the extensor tendon. This demonstrates intermediate T2 signal, hypointense T1 signal, and lack of central enhancement. This may reflect undermining of the sinus tract versus separate developing abscess. Locules of gas in this region.
Marrow edema in the great toe proximal and distal phalanges with confluent loss of T1 signal. There is loss of cortex along the medial aspect of the proximal and distal phalanges. These findings are consistent with osteomyelitis.
There is decreased and possibly absent enhancement along the medial head proximal phalanx which is suspicious for loss of bone viability. Susceptibility artifact at this location suggests marrow gas. Otherwise, contrast enhancement is present elsewhere in the involved bones.
No other marrow changes concerning for osteomyelitis in the left forefoot.
Nonenhancing edema along the dorsum of the foot, not compatible with cellulitis.
Edema and enhancement of the intrinsic muscles of the foot, compatible with diabetic myopathy.
Impression
Acute osteomyelitis involving the entire proximal and distal phalanges of the great toe.
Finding concerning for loss of bone viability along the medial head of the proximal phalanx.
Focal signal abnormality along the dorsal aspect of the great toe, either reflecting further undermining of the ulcer versus developing abscess.
