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Case Notes

History

Left toe cellulitis and ulcer. Evaluate for osteomyelitis.

Exam

MR images of the left forefoot were obtained before and after the intravenous administration of gadolinium based contrast material.

Prior Study

Dicom

Findings

You scored: 0 / 21

Limitations	Correct Answer	Your Answer
There is patient motion or other limitations.	No	NA

Skin/Hypodermis	Correct Answer	Your Answer
There is edema or hyperenhancement.	Yes	NA
There is soft tissue ulceration or sinus tract.	Yes	NA
There is gas or foreign body.	Yes	NA
There is confluent hypoenhancement to suggest phlegmon, suppuration, abscess, or drainable fluid collection in the hypodermis.	Yes	NA

Investing/Intermuscular Fascia	Correct Answer	Your Answer
There is edema, thickening, or hyperenhancement.	No	NA
There is hypoenhancement or gas/susceptibility artifact.	No	NA
There is bulging of the fascia.	No	NA

Muscles	Correct Answer	Your Answer
There is edema or hyperenhancement.	Yes	NA
There is hypoenhancement, lack of enhancement, or organized fluid collection.	No	NA
There is fatty atrophy.	No	NA

Bones	Correct Answer	Your Answer
There are fractures.	No	NA
There is periosteal reaction, osseous destruction, or other abnormal marrow to suggest osteomyelitis.	Yes	NA
There is osseous hypoenhancement or lack of enhancement to suggest loss of bone viability.	No	NA
There is cloaca, sequestrum, or involucrum.	No	NA
There is a subperiosteal or intra-osseous abscess.	No	NA

Visualized Joints	Correct Answer	Your Answer
There is a joint effusion or synovitis.	No	NA
There is malalignment, degenerative changes, or other gross internal derangement.	No	NA

Miscellaneous	Correct Answer	Your Answer
There is tenosynovitis.	No	NA
Major visualized vascular structures are abnormal.	No	NA
Major visualized nerves are abnormal.	No	NA

Impression

Expert Answer

Soft tissue ulcer along the medial/plantar aspect of the great toe.

Your Answer

Recommendations & Acuity

Recommendations

Expert Answer

Surgical consultation.

Your Answer

Acuity

Expert Answer

Urgent (Action Necessary in a few hours)

Your Answer