PMC6587020_01
Shows right plantar surface with erythematous, desquamating skin, and a 2x3 cm chronic ulcer with eschar.
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Physical exam revealed an erythematous, 2 x 3 cm chronic ulcer, with eschar and minimal serous drainage, on his right plant surface (Fig. 1).
X-ray of the right foot - arrow showing erosion of the fifth metatarsal head. Screw on the head of the third metatarsal from prior surgery. Osteopenia present. Soft tissue swelling is present.
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Radiography of the right foot showed diffuse erosive and lytic lesions concerning for multifocal osteomyelitis (Fig. 2, Fig. 3).
MRI of the right foot - shows diffuse soft tissue swelling with mild contrast enhancement along the plantar aspect of the right foot likely representative of cellulitis. No adjacent ulceration or abscess formation. Indeterminate, multifocal intramedullary enhancing soft tissue masses with cortical erosions and soft tissue components throughout the osseous structures of the right foot.
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Magnetic resonance imaging of the right foot done with intravenous contrast showed diffuse soft tissue swelling with mild enhancement along the plantar surface, concerning for acute cellulitis, plus multifocal intermedullary enhancing soft tissue masses with cortical erosions and soft tissue components throughout the osseous structures of the right foot (Fig. 4).