This male patient was born in India and presented with indolent right leg pain. Initially, he stated the pain had been for several weeks. Upon further questioning, it was revealed he had intermittent leg pain for several months prior to presentation. 

The imaging findings are characteristic of osteomyelitis. This patient underwent an ultrasound-guided aspirate of the soft tissue collection, which grew mycobacterium tuberculosis. 

The clues are in the history and demographics. The patient's name and presentation raise suspicion of tuberculosis, which is endemic in India. 

The radiographic findings demonstrate an aggressive lesion in the typical location of osteomyelitis; however, other aggressive processes such as cancer need to be excluded by bone scan.

The bone scan confirms there is a solitary lesion in the right proximal tibia, which can only be a focal infective process or primary osseous malignancy. 

The MRI confirms osteomyelitis. There is pus within the bone, which has escaped into the soft tissues via a cloaca in the anterior tibial cortex. 

Notice the extent of the infection in the tibia. If this were pyogenic osteomyelitis the patient would be more systemically unwell and with more severe pain. Often, tuberculosis osteomyelitis is a more indolent process with only mild pain and/or systemic symptoms despite extensive disease.