Osteomyelitis - lateral malleolus

Case contributed by Bahman Rasuli
Diagnosis almost certain

Presentation

Diabetic patient from 15 years ago was referred with fever, left-sided lateral malleolus pain, and ulcer with pus discharge from its lateral aspect from 8 months ago and intractable to medical treatment.

Patient Data

Age: 45 years
Gender: Male
  • bone marrow signal changes (T1 hypointense, T2, and PD hyperintense) involving the lateral malleolus

  • a sinus tract from the lateral malleolus into the skin in the lateral aspect

  • edema and fluid signal intensity within the hindfoot subcutaneous tissues

  • fluid signal surrounding the peroneus tendons

  • abnormally intrasubstance increased fluid signal and fibers discontinuity along with peroneus tendons due to partial tearing

Case Discussion

MRI imaging findings of the left ankle including lateral malleolus bone marrow edema, sinus tract, and soft tissue inflammation are characteristic of chronic osteomyelitis complicated by infective tenosynovitis of peroneus tendons with partial tearing.

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