MRI
Axial T1
Axial T1 C+
Axial T2 fat sat
Coronal T1 C+
Coronal STIR
Sagittal T2 fat sat
An 11 x 3 x 2 cm right proximal tibial lesion is identified in the metadiaphyseal region. It is centred in the medullary cavity and demonstrates thick rim enhancement on T1 contrast sequences and central low T1/high T2 signal. The margins of the lesion are irregular and lobulated, with foci of endosteal scalloping. There is a breach in the anterior tibial cortex best appreciated on the sagittal T2 reconstructions, which communicates with a similar appearing rim enhancing lesion in the anteromedial leg soft tissues, measuring 4.6x1x7.5cm. Extensive overlying subcutaneous oedema.
The muscles in the leg appear unremarkable and intact. Unremarkable appearances of the neurovascular bundle. Normal appearances of the fibula and distal tibia.
CONCLUSION: Appearances are consistent with osteomyelitis of the proximal tibia. A cloaca in the anterior tibial cortex drains into a soft tissue collection in the anteromedial leg.