PMC6195932_01
(a) Photograph of the medial aspect of the right leg of a 43-year-old male-to-female transgender with migration of silicone material to the legs following silicone injections in the buttocks showing a cutaneous necrotic ulcer following partial debridement. (b) Lateral view of the right and the left leg (c) showing evidence of scarred cutaneous ulcers.
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Inspection of the right leg revealed a 3.5 x 3.0 x 0.8 cm necrotic skin ulcer proximal to the medial malleolus (Figure 1) with foul-smelling serous discharge and diffuse erythema of the foot.
(a) Lateral and (b) frontal radiographs of the right leg demonstrating diffuse thickening and reticular, micronodular infiltration of the subcutaneous soft tissues and the presence of two cutaneous ulcerations (arrows) without evidence of soft-tissue calcification or osteomyelitis.
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Radiography (Figure 2), ultrasonography (Figure 3) and MRI (Figure 4) of the right leg were performed to rule out osteomyelitis and assess the extent of soft tissue involvement.
(a) Longitudinal extended-field-of-view ultrasono-graphy scan of the anterolateral aspect of the right leg and (b) transverse ultrasonography scan of the anterolateral aspect of the left leg showing normal appearance of the dermis (arrows) and diffuse hyperechogenicity of the subcutaneous tissues (asterisks) with strong posterior acoustic shadowing masking the deeper structures. This "snowstorm pattern" is consistent with liquid silicone filler.
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Radiography (Figure 2), ultrasonography (Figure 3) and MRI (Figure 4) of the right leg were performed to rule out osteomyelitis and assess the extent of soft tissue involvement.
(a) Coronal T
1 weighted image of the right leg depicting diffuse intermediate signal of the subcutaneous tissues and two cutaneous ulcers (arrows). (b) Slightly more anterior coronal short tau inversion-recovery image showing diffuse micronodular hyperintense signal in the cutaneous and subcutaneous tissues and the skin ulcer proximal to the medial malleolus (arrowhead). The osseous structures and muscles are intact without evidence of infection. There is no ferromagnetic artefact or other evidence of foreign body material.
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Radiography (Figure 2), ultrasonography (Figure 3) and MRI (Figure 4) of the right leg were performed to rule out osteomyelitis and assess the extent of soft tissue involvement.