PMC9937681_01
CT of the right femur #1 and #2. CT femur #1 (A, C, E, and G) without IV contrast and CT femur #2 (B, D, F, and H) with IV contrast were performed five days after CT femur #1. Transverse CT images of the right femur show cross sections descending from superior to inferior. The images on the left demonstrate initial findings that were suspicious of a soft tissue skin infection, and the images on the right were taken five days later, demonstrating the development of extensive necrotizing fasciitis. Images B and D show intra- and intermuscular abscesses with a concomitant reduction in muscle volume and size, namely the sartorius, rectus femoris, vastus medialis, vastus intermedius, and vastus lateralis. Images F and H show increasing rim-enhancing lesions of the medial compartment with necrosis of the adductor brevis, adductor longus, and adductor magnus.. CT: computed tomography; IV: intravenous
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FIG1
CT of the right femur without intravenous (IV) contrast (Figures 1A, 1C, 1E, 1G), indicated for worsening cellulitis, revealed fluid tracking along the lateral compartment muscles, which raised suspicion for an abscess. Cultures of the right knee revealed methicillin-resistant A CT of the right femur with IV contrast (Figures 1B, 1D, 1F, 1H, 2) was performed a few days later and demonstrated a considerable increase in rim-enhancing fluid collections intramuscularly and extending into both the anterior and posterior compartments, likely correlating with increasing intermuscular and intramuscular abscesses.
CT of the right femur #2. The rim-enhancing lesion extends the entire iliotibial band in the coronal view CT of the right femur #2 with IV contrast. Subcutaneous stranding indicative of cellulitis is also noticeable on the entire lateral aspect of the right femur.
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FIG2
A CT of the right femur with IV contrast (Figures 1B, 1D, 1F, 1H, 2) was performed a few days later and demonstrated a considerable increase in rim-enhancing fluid collections intramuscularly and extending into both the anterior and posterior compartments, likely correlating with increasing intermuscular and intramuscular abscesses.
Osteomyelitis of the right knee. A large right knee effusion with enhancing synovium and osteolytic nidus medial patella (arrow) is seen in a transverse view of the right knee on CT of the right femur #2 with IV contrast. Septic arthritis and osteomyelitis are confirmed at debridement surgery.
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FIG3
Patellar osteomyelitis was also noted on imaging (Figure 3).