Great toe osteomyelitis

Case contributed by Bahman Rasuli
Diagnosis almost certain

Presentation

Type 2 diabetic for 18 years, referred with great toe ulcer.

Patient Data

Age: 65 years
Gender: Male
mri
This study is a stack
Sagittal
PD fat sat
This study is a stack
Sagittal
T1
This study is a stack
Axial
T1
This study is a stack
Axial PD
fat sat
This study is a stack
Coronal
STIR
This study is a stack
Coronal
T1
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Info

Extensive bone marrow signal changes (T1 hypointense, STIR, and PD hyperintense) involve the great toe distal phalanx. 

A sinus tract is seen from the great toe distal phalanx to the skin along the distal medial surface.

Abnormal bone marrow signal (iso on T1 and high on STIR/PD fs) at the great toe proximal phalanx due to osteitis.

Edema and fluid signal intensity within the great toe subcutaneous tissues, forefoot and midfoot intrinsic muscles, and subcutaneous tissues at dorsal and plantar aspects are seen.

Case Discussion

Regarding the imaging findings, great toe distal phalanx osteomyelitis is the main diagnosis.

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