Limits...
• Osteomyelitis of the head of the left, first metatarsal • Osteomyelitis of the medial sesamoid bone • Myositis of the plantar muscles of the foot • Cellulitis of the plantar aspect of the foot

Adams BLA - MedPix (2006)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: • Osteomyelitis of the head of the left, first metatarsal • Osteomyelitis of the medial sesamoid bone • Myositis of the plantar muscles of the foot • Cellulitis of the plantar aspect of the foot

History: The patient is an 83-year-old, African-American woman with a history of diabetes mellitus, hypertension, hyperlipidemia, hepatitis C, and neurosyphilis, who was admitted to the hospital for worsening of a chronic, nonhealing, left-foot ulcer that had been followed closely by the Podiatry service with repeated debridements and courses of oral antibiotics. On the current admission, the patient denied having had any fevers, chills, or feelings of malaise, but stated that her glycemic control had been poor.

Findings: Anteroposterior and oblique radiographs of the left foot show severe osteopenia of the bones of the foot and ankle, as well as extensive calcifications of the visualized arteries of the foot. There is erosion of the medial aspect of the head of the first metatarsal and thickening of the adjacent medial soft tissues. Additionally, there is ulceration (1.2 cm in length) in the superficial soft tissues medial to the head of the first metatarsal. Also radiographs showed incidental findings of metatarsus primus varus with hallux valgus deformities. T1-weighted, axial MR images of the left foot show extensive areas of low-signal intensity around the head of the first metatarsal and the medial soft tissues. Fast spin echo (FSE), T2-weighted with fat saturation, axial MR images of the left foot and short tau inversion recovery (STIR) sagittal MR images show that areas of low-signal intensity on T1-weighted MR images (the soft tissues) become areas of high-signal intensity. There are also areas of high-signal intensity in the head of the first metatarsal and the distal metaphysis and in the tibial (medial) sesamoid bone. These fat-suppressed MR images also show areas of high-signal intensity in the plantar muscles. Post-contrast T1-weighted with fat saturation MR images of the left foot in both the axial (not shown) and sagittal planes show enhancement of the head of the first metatarsal, the tibial sesamoid, and surrounding soft tissues. On post-contrast MR images, no necrosis in muscles or soft tissues, manifested by nonenhancing areas, are found. These combined findings on fat-suppressed and contrast-enhanced MR images are consistent with myositis and cellulitis of the soft tissues and osteomyelitis of the head of the first metatarsal and tibial sesamoid. The tendons of the tarsus and foot are normal.

Ddx: The image findings of these studies are definitive for osteomyelitis with cellulitis and myositis.

Dxhow: The diagnoses were confirmed by the imaging coupled with the patient’s history, clinical presentation, and physical examination findings.

Exam: Physical examination revealed a 2x2-cm ulceration superficial to the medial aspect of the head of the left, first metatarsal. Hemoglobin A1c taken one month prior to admission was 10% (normal range 4.5% - 5.7%)

No MeSH data available.


T1-weighted, axial MR image of the left foot showing extensive areas of low-signal intensity around the head of the first metatarsal and the medial soft tissues.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=MPX1390&req=5

MPX1390_synpic29158: T1-weighted, axial MR image of the left foot showing extensive areas of low-signal intensity around the head of the first metatarsal and the medial soft tissues.


• Osteomyelitis of the head of the left, first metatarsal • Osteomyelitis of the medial sesamoid bone • Myositis of the plantar muscles of the foot • Cellulitis of the plantar aspect of the foot

Adams BLA - MedPix (2006)

T1-weighted, axial MR image of the left foot showing extensive areas of low-signal intensity around the head of the first metatarsal and the medial soft tissues.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1390&req=5

MPX1390_synpic29158: T1-weighted, axial MR image of the left foot showing extensive areas of low-signal intensity around the head of the first metatarsal and the medial soft tissues.

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: • Osteomyelitis of the head of the left, first metatarsal • Osteomyelitis of the medial sesamoid bone • Myositis of the plantar muscles of the foot • Cellulitis of the plantar aspect of the foot

History: The patient is an 83-year-old, African-American woman with a history of diabetes mellitus, hypertension, hyperlipidemia, hepatitis C, and neurosyphilis, who was admitted to the hospital for worsening of a chronic, nonhealing, left-foot ulcer that had been followed closely by the Podiatry service with repeated debridements and courses of oral antibiotics. On the current admission, the patient denied having had any fevers, chills, or feelings of malaise, but stated that her glycemic control had been poor.

Findings: Anteroposterior and oblique radiographs of the left foot show severe osteopenia of the bones of the foot and ankle, as well as extensive calcifications of the visualized arteries of the foot. There is erosion of the medial aspect of the head of the first metatarsal and thickening of the adjacent medial soft tissues. Additionally, there is ulceration (1.2 cm in length) in the superficial soft tissues medial to the head of the first metatarsal. Also radiographs showed incidental findings of metatarsus primus varus with hallux valgus deformities. T1-weighted, axial MR images of the left foot show extensive areas of low-signal intensity around the head of the first metatarsal and the medial soft tissues. Fast spin echo (FSE), T2-weighted with fat saturation, axial MR images of the left foot and short tau inversion recovery (STIR) sagittal MR images show that areas of low-signal intensity on T1-weighted MR images (the soft tissues) become areas of high-signal intensity. There are also areas of high-signal intensity in the head of the first metatarsal and the distal metaphysis and in the tibial (medial) sesamoid bone. These fat-suppressed MR images also show areas of high-signal intensity in the plantar muscles. Post-contrast T1-weighted with fat saturation MR images of the left foot in both the axial (not shown) and sagittal planes show enhancement of the head of the first metatarsal, the tibial sesamoid, and surrounding soft tissues. On post-contrast MR images, no necrosis in muscles or soft tissues, manifested by nonenhancing areas, are found. These combined findings on fat-suppressed and contrast-enhanced MR images are consistent with myositis and cellulitis of the soft tissues and osteomyelitis of the head of the first metatarsal and tibial sesamoid. The tendons of the tarsus and foot are normal.

Ddx: The image findings of these studies are definitive for osteomyelitis with cellulitis and myositis.

Dxhow: The diagnoses were confirmed by the imaging coupled with the patient’s history, clinical presentation, and physical examination findings.

Exam: Physical examination revealed a 2x2-cm ulceration superficial to the medial aspect of the head of the left, first metatarsal. Hemoglobin A1c taken one month prior to admission was 10% (normal range 4.5% - 5.7%)

No MeSH data available.