Wk 3, Case 1 - Review

Patient History
8-year-old female with right 2nd digit cellulitis.

Findings

LIGAMENTS: Noncontributory.

OSSEOUS: Cortical erosion with diffusely decreased T1 and concomitant increased T2 signal throughout the right 2nd digit distal phalanx with diffuse enhancement in keeping with “bone erasure sign”. Subtle enhancement is seen within the growth plate of the proximal distal phalanx and distal interphalangeal joint.

TENDONS: Flexor tenosynovitis extends to the level of the base of the proximal phalanx. Extensor tenosynovitis extends to the level of the distal proximal phalanx.

GENERAL: Diffuse edema throughout the dorsal and palmar aspects of the 2nd digit with heterogeneous enhancement; subtle punctate areas of susceptibility within the palmar radial aspect at the 2nd tuft.

A well-circumscribed rim-enhancing fluid collection representing an abscess overlies the volar aspect of the 2nd digit distal phalanx measuring approximately 8 mm x 4 mm x 8 mm (craniocaudal, AP and transverse diameters) producing separation at the level of the flexor digitorum profundus insertion.

Impressions
1.Osteomyelitis of the right 2nd digit distal phalanx.
2.Volarly positioned subperiosteal versus soft tissue abscess separating the flexor digitorum profundus at its insertional level.
3.Subtle enhancement at the growth plate and the IP joint potentially representing septic arthritis.
4.Confluent phlegmon and cellulitis throughout the 2nd digit with punctate susceptibility artifacts at the tuft that might represent gas versus a foreign body.