Hi, this is Sagar Wagle, one of the musculoskeletal radiology fellows at Stanford University. We have a case of a 16 year old male with purulent drainage from right heel blister. Here is the image of the wound. On radiograph on the right, we see the heel ulcer. There is no obvious erosion of the underlying bone to suggest osteomyelitis. However, x-rays are insensitive for detection of osteomyelitis. MRI is the most sensitive. Here we have a case of a 35 year old female with lupus and heel wound. We see a large wound on the heel. There is no obvious erosion of the bone to suggest osteomyelitis. Let's look at the MRI. This is T1 weighted image. This is T2 FATSAT. The bright signal on T2 FATSAT indicates bone marrow edema. Normal bone marrow should appear dark like this. And on T1, this T1 hypo intense marrow signal corresponds to osteomyelitis. Normal signal of bone marrow should be like this on the T1 weighted image. Here we can look at osteomyelitis in our case versus normal MRI on the right. I have another case of a 55 year old patient with pressure ulcer on the heel. Here we can see skin irregularity corresponding to the pressure ulcer. There is subtle bone erosion here, which is a little bit difficult to see. Let's look at the MRI on the right. This is T1 weighted image. And again, this T1 hypo intense marrow signal corresponds to osteomyelitis. This patient has an additional finding in the Achilles tendon. Achilles tendon should appear nice and dark like this. But as you go below, it has increased signal. So this person also had tendinitis of the Achilles tendon as a result of the ulcer. Here we can look at our MRI versus a normal MRI. And let's compare the T1 hypo intense marrow signal with normal T1 signal. And also let's look at our abnormal Achilles tendon and compare it with a normal Achilles tendon. Thank you for watching the video.

3rd Edition, CASE 26

3rd Edition

Infectious Disease

osteomyelitis

MRI

heel wounds

radiological evaluations

bone marrow edema