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Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
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Unlock access to our full Course Library and all self-paced Fellowships.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
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Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
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For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
Practice Cases
Week 1
6 topics, 11 min.
Practice Cases
Week 2
6 topics, 18 min.
Practice Cases
Week 3
6 topics, 27 min.
Practice Cases
Week 4
6 topics, 7 min.
Practice Cases
Week 5
6 topics, 45 min.
0:00
This is a 78-year-old man with a history
0:03
of blistering along the dorsal aspect
0:06
of the foretoe and purulent drainage.
0:10
On T1-weighted images, there is replacement
0:12
of the marrow by low signal intensity
0:15
centered at the distal interphalangeal joint
0:19
at the site of soft tissue abnormality.
0:23
Fluid-sensitive sequences demonstrate
0:26
the presence of cortical erasure sign.
0:29
We see complete indistinctness of
0:32
the cortex at the site of
0:35
abnormality, centered at the
0:38
distal interphalangeal joint.
0:40
These findings are consistent with osteomyelitis,
0:45
even more so in the setting of a known skin
0:48
ulceration with purulent drainage.
0:52
On MPR
0:54
reconstructed images,
0:56
we can see the area of interest because we
1:00
are doing a reformat going across the distal
1:05
interphalangeal joint, and that allows us to
1:08
better define the presence of erosions of
1:12
the subchondral plate with associated marrow
1:15
signal abnormality and loss of the cortical
1:19
outline in the setting of acute osteomyelitis.
Wk 2, Case 4 - Review
HIDEInteractive Transcript
0:00
This is a 78-year-old man with a history
0:03
of blistering along the dorsal aspect
0:06
of the foretoe and purulent drainage.
0:10
On T1-weighted images, there is replacement
0:12
of the marrow by low signal intensity
0:15
centered at the distal interphalangeal joint
0:19
at the site of soft tissue abnormality.
0:23
Fluid-sensitive sequences demonstrate
0:26
the presence of cortical erasure sign.
0:29
We see complete indistinctness of
0:32
the cortex at the site of
0:35
abnormality, centered at the
0:38
distal interphalangeal joint.
0:40
These findings are consistent with osteomyelitis,
0:45
even more so in the setting of a known skin
0:48
ulceration with purulent drainage.
0:52
On MPR
0:54
reconstructed images,
0:56
we can see the area of interest because we
1:00
are doing a reformat going across the distal
1:05
interphalangeal joint, and that allows us to
1:08
better define the presence of erosions of
1:12
the subchondral plate with associated marrow
1:15
signal abnormality and loss of the cortical
1:19
outline in the setting of acute osteomyelitis.
Report
Patient History
78-year-old man with a one-month history of a blister on the third left toe with purulent drainage.
Findings
Skeletal/osseous:
Cortical destruction with diffuse confluent osteoedema involving the 3rd toe distal phalanx (mid to proximal portion), middle phalanx (mid to distal portion). Cortical destruction at the distal interphalangeal joint with partial lateral subluxation of the distal phalanx. Proximal interphalangeal joint preserved. Proximal phalanx preserved. No intraosseous abscess/fluid collection or involucrum identified. No sequestrum or cloaca.
Marked hallux valgus deformity with moderate to marked 1st metatarsophalangeal joint osteoarthropathy. Marked hammertoe deformities of the 2nd to 5th toes. Varus deformities of the 2nd to 5th metatarsophalangeal joints.
Moderate to marked lateralization of the sesamoids, due to the hallux valgus deformity. Marked tibial and moderate fibular sesamoid hallux arthrosis. Flattening of the crista and sesamoid grooves.
No micro- or macro-trabecular fracture.
Tendons:
Visualized portions intact.
Ligaments:
Thickened medial and lateral collateral ligaments of the 1st metatarsophalangeal joint.
Plantar plates:
Stretched plantar plates. No macro tear.
Soft tissues:
Soft tissue callus formation/thickening at the plantar aspect of the 5th metatarsal head. Soft tissue thickening/callus formation with fatty atrophy/thinning adjacent to the medial aspect of the 1st metatarsal head.
Extensive soft tissue thickening surrounding the nail bed and dorsal aspect of the distal 3rd toe.
No bulky Morton neuroma. No intermetatarsal bursitis with effusion.
Other:
Partially imaged plantar fascia unremarkable. Diffuse mild fatty infiltration and muscle edema of the intrinsic musculature of the forefoot.
Impressions
1. Osteomyelitis involving the 3rd toe middle phalanx and proximal segment of the distal phalanx with DIPJ septic arthritis. Possible contiguous extension from an adjacent nailbed infection. Proximal interphalangeal joint preserved.
2. Marked hallux valgus deformity with lateralized sesamoids. Moderate to marked degenerative arthrosis 1st MTPJ, tibial hallux-sesamoid and moderate fibular hallux-sesamoid arthrosis.
3. Incidental 2nd through 5th hammertoe deformities.
4. Incidental mild diffuse fatty infiltration and muscle edema of the intrinsic forefoot musculature. Assessment for systemic neuropathy recommended.
Case Discussion
Faculty
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
ProScan Imaging
Todd D. Greenberg, MD
Radiologist
ProScan
Tags
Musculoskeletal (MSK)
MRI
Foot & Ankle
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