A: A DP view of the toes shows marked soft tissue edema in the foot and particularly in the great toe, as well as a very large amount of soft tissue gas.

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Presentation transcript:

A: A DP view of the toes shows marked soft tissue edema in the foot and particularly in the great toe, as well as a very large amount of soft tissue gas within the great toe. The findings represent cellulitis and soft tissue gangrene. There is significant osteolysis of the head of the proximal phalanx of the great toe with destruction of the medial cortex. There is some apparent osteolysis of the distal phalanx as well. The interphalangeal joint of the great toe is severely narrowed; is the setting of infection, septic arthritis is suspected. B-E: Coronal T1, FS T1, Fs T2, and Gd-enhanced Fs T1-weighted images of the same foot show replacement of the normal T1 hyperintense marrow signal within the proximal and distal phalanges of the great toe as well as the first metatarsal head. There is extensive marrow edema and corresponding enhancement within the same bones. Prominent erosions are evident in the first metatarsal head, not visible on the conventional radiographs, even in retrospect. There are no areas within the affected bones which fail to enhance; therefore, there is no evidence of devitalized bone. There is extensive edema and enhancement within the surrounding soft tissues consistent with cellulitis. The small foci of signal dropout are due to the soft tissue gas. There are no fluid collections. Source: Chapter 10. Lower Extremity, The Atlas of Emergency Radiology Citation: Block J, Jordanov MI, Stack LB, Thurman R. The Atlas of Emergency Radiology; 2013 Available at: http://accessemergencymedicine.mhmedical.com/DownloadImage.aspx?image=/data/books/bloc1/bloc1_c010f117e.png&sec=42499708&BookID=573&ChapterSecID=42496372&imagename= Accessed: October 21, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved