Assessment #1 case-set #2 case #1

cellulitis, likely OM

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Subcutaneous gas and underlying cortical irregularity about the 1st and second MTPs. Concerning for infection and underlying osteomyelitis. No acute fracture. The joint spaces are maintained. No radiopaque foreign body.

Soft tissue gas in the first inter-metatarsal space with suggestion of subtle osteolysis of the first digit. Concerning for infection with gas forming organism, surgical emergency,

Subcutaneous emphsyema surrounding the soft tissues of the great toe concerning for gas-producing infection. No acute fracture. No definite osteolysis.

Extensive subcutaneous emphysema and soft tissue swelling about the forefoot with possibly underlying focal bony erosive changes. MRI could be considered for further evaluation.

soft tissue edema and subcutaneous gas tracking along the dorsum and plantar aspect of the forefoot. Permeative appearance of the second metatarsal head with evidence of cortical destruction suspicious for osteomyelitis. Recommend MRI for further evaluation.

cellulitis with gas-forming organism

extensive sq gas

Gas locules overlying the first through fourth metatarsal and digits, most significantly the first toe concerning for infection. No evidence of bony erosion. Recommend foot MRI for evaluation.
Swelling of the dorsal and plantar aspects of the foot.
No fracture or dislocation.

findings concerning for Osteomyelitis of the heads of the first and second metatarsal heads

subcutaneous emphysema concerning for nec fasc

No fracture. Significant soft tissues swelling of the medial forefoot centered around the first metatarsal and phalanx, with cortical indistinctness of the adjacent bone concerning for acute osteomyelitis.

osseous erosion of the first proximal and distal phalanges likely with extension into the 2nd metatarsal and proximal phalanx, concerning for osteomyelitis. soft tissue swelling and subcutaneous emphysema over the dorsal aspect of the foot and great toe, suspicious for necrotizing fasciitis

FINDINGS:

There is marked soft tissue gas surrounding the first MTP joint with associated swelling. No erosive changes are seen. No acute fracture or dislocation. Mild degenerative changes in the midfoot.

IMPRESSION:

Marked soft tissue gas surrounding the first MTP joint, raising concern for necrotizing soft tissue infection. While no erosive bone lesions are seen, an underlying osteomyelitis should also be considered.

Soft tissue gas, cortical destruction c/f osteomyelitis

Soft tissue emphysema overlying the first and second toe concerning for infection. No joint destruction to suggest septic joint.

Soft tissue infection of the right foot most prominent near the 1st proximal phalanx. No definite radiographic evidence of osteomyelitis. No fracture or dislocation.

evidence of osteomyelitis with cortical loss at the 2nd, 3rd, and 4th metatarsal heads

Subcutaneous emphysema and edema

subcutaneous gas surrounding first digit metatarsal/prox phalanx/distal phalanx, second digit (surr. metatarsal/prox phalanx), third digit (metatarsal), and fourth digit (metatarsal), dorsum/plantar foot. Concern for Nec fasc vs cellulitis. No definitive bony involvement; however mri more sensitive for osteo.

degen-mild 1st mtt and midfoot

Cortical destruction of a portion of the 2nd MT head. Soft tissue ulcer at the head of the 1st MT. Locules of gas within the adjacent soft tissues. No acute fracture or malalignment.

Lucent lesion of the distal phalanx of the first digit, with surrounding soft tissue swelling. Findings consistent with osteomyelitis. Recommend MRI.

osteomyelitis involving the 2nd metatarsal head with associated swelling and subcutaneous emphysema.

Soft tissue gas centralized over the plantar and dorsal aspect of the 1st MTP joint, with extension proximally to the midfoot and distally towards the digits. Likely dorsal subluxation of the 1st proximal phalanx with respect to the 1st metatarsal, with flattening of the 1st metatarsal head. This likely reflects an infectious process, with possible ulceration along the medial/plantar aspect of the 1st metatarsal.

Soft tissue ulceration along the medial plantar surface of the forefoot with surrounding edema and subcutaneous gas tracking up the fascial planes along the plantar and dorsal aspects of the foot, concerning for acute necrotizing fasciitis. Recommend surgical consultation.

Periosteal reaction and regional osteopenia across the forefoot likely represents acute osteomyelitis. No fracture or malalignment.

Soft tissue swelling and gas projecting over the forefoot concerning for necrotizing soft tissue infection. Indistinctness of the cortex of the first and second metatarsals concerning for osteomyelitis.

Soft tissue gas along the forefoot, concerning for necrotizing fasciitis.

Medial distal and midfoot soft tissue swelling with diffuse subcutaneous locules of gas. findings are concerning for necrotizing fasciitis. Rec urgent surgical evaluation.

Soft tissue swelling with extensive subcutaneous gas in the forefoot concerning for necrotizing fasciitis.

No acute fracture.

Test report

Osteonecrosis of the distal first and second metatarsals, and 1st PIP and 2nd PIP. Overlying dorsal and plantar subcutaneous emphysema.

No acute fracture.
Soft tissue swelling about the forefoot, with soft tissue gas. Small ulceration at the medial aspect of the 1st MTP joint. No definitive osseous destruction. Consider MRI for evaluation of osteomyelitis.

Subcutaneous gas pin the dorsal and plantar soft tissues of the medial forefoot and tracking toward the midfoot. Osseous destruction of the first distal phalynx on lateral view. Plantar forefoot soft tissue laceration. Findings concerning for osteomyelitis and gangrene.

No acute fx or malalignment.

Subcutaneous gas throughout the soft tissues of the forefoot adjacent to the 1st and second metatarsal and phalanges concerning for gangrenous infection. No acute fracture or malalignment.

Soft tissue cellulitis without definite oosseus erosions.

Extensive subcutaneous emphysema and swelling along the dorsum and plantar aspects of the forefoot concerning for infection, with necrotizing etiologies remaining a differential consideration. Possible osseous erosions along the medial aspect of the second and third metatarsal heads which may represent osteomyelitis. MRI could further evaluate these findings. No evidence of pathologic fracture.

1. Extensive subcutaneous gas and soft tissue swelling around the hallux with erosive changes at the medial aspect of the distal phalanx of the hallux suggesting acute osteomyelitis. Additional gas along the 2nd, 3rd, and 4th digits without evidence of erosive changes.
2. No acute fracture or traumatic malalignment.
3. Mild midfoot degenerative changes.
3. Plantar calcaneal enthesopathy.

Apparent linear skin defect along the plantar aspect of the great toe with soft tissue gas tracking along the lateral aspect of the toe and first web space. Erosion of the lateral aspect of the base of the 1st distal phalanx concerning for acute osteomyelitis. Consider MRI for further evaluation.

soft tiusuue gas of the forefoot wmost prominent in between the 1st and 2nd digist w/ adjacent osseous erosions of the 1-3rd metatarsal heads concerning for osteomyelitis.

Prominent subcutaneous gas throughout the soft tissues of the medial forefoot, most notably within the soft tissues between the first and second proximal phalanges. Open soft tissue wound in the same space.

Query erosive changes of the second metatarsal head. Recommend MRI to further evaluate for osteomyelitis.

No foreign body.

-Subcutaneous gas tracking along the soft tissues of the plantar and dorsal foot concerning for necrotizing fasciitis. Consider emergent debridement.
-Possible osseseous erosion of the medial aspect of the base of the first distal phalanx.
-soft tissue swelling

subcutaous gas with cortical bone destrruciton and destructive medullary modeling of f2nd 3rd distal metatarsals extneign into interarsal s

Extensive subcutaneous emphysema more pronounced around the first MCP and and prox phalanx, concern for nec fasciitis.

subcutaneous emphysema about the forefoot dorsal and plantar surfaces, most pronounced about the lateral soft tissues of the great toe, likely cellulitis. Erosion about the lateral base fo the 1st distal phalanx, concerning for osteomyelitis. Posttraumatic deformities of the 4th and 5th proximal phalanges. Mild degenerative changes of the midfoot, 1st TMT, 1st MTP, and 1st IP joints. Calcaneal enthesopathy. Small ossific fragments dorsal to the posterior process of talus, likely from remote trauma versus degenerative.

Extensive soft tissue edema extending through the fascial planes along the medial 1st digit phalanges and metatarsal. This could be seen n cellulitis, however, due to the extent of soft tissue involvement, necrotizing fasciitis can’t be excluded. There is extension along the 2nd digit metatarsal and proximal phalanx. There is slight cortical erosion along the medial aspect of the 1st IP joint, which could be seen in developing osteomyelitis. MRI could be considered for further characterization of possible osteomyelitis.
mild degenerative changes of the midfoot and 1st MTP and IP joints.

Erosions concerning for osteo of 1 and 2
Subq emphysema

no acute fx or malalignment.
soft tissue gas about the forefoot suggestive of necrotizing infxn. no cortical destructio to suggest osteo.

Soft tissue edema and gas about the forefoot concerning for acute necrotizing infection. No radiographic evidence of osteomyelitis, though plain radiography is relatively insensitive and MRI should be considered if there is clinical concern.

Subcutaneous gas extending from wound on the plantar surface of the foot subjacent to the metatarsal heads, between the first and second MTP joints, proximally along the dorsal surface of the foot to about the base of the metatarsals and along the plantar fascia, and distally along the lateral surface of the first toe, which is concerning for necrotizing fasciitis. Indistinct cortex of the medial surface of the second metatarsal head is concerning for osteomyelitis. Recommend surgical consult and MRI of the foot for further evaluation.

Extensive soft tissue edema, fat stranding, and gas surrounding the lateral aspect of the first digit and involving the soft tissues lateral to the second through forth toes to a lesser extent.

There is focal osteopenia involving the distal metacarpals and phalanges, most severe at the first distal phalanx, concerning for acute osteomyelitis. MRI could further assess chronicity.

Acute fracture along the plantar aspect of the proximal first phalanx which extends into the IP joint.

Calcaneal enthesophytes.

Non-specific calcifications posterior to the posterior process of the talus.

Extensive air throughout the soft tissue overlying the forefoot, centered on the web space between the 1 and 2 proximal phlanges. Soft tissue swelling with soft tissue defect of the plantar aspect of the forefoot. These findings are concerning for necrotizing soft tissue infection. Recommend emergent surgical consultation.

Although no obvious osseous erosion, osteopenia of the forefoot is concerning for osteomyelitis.

Extensive subcutaneous gas and swelling of the soft tissue overlying the medial plantar forefoot and mid foot, concerning for aggressive soft tissue infection.

Erosion and periosteal reaction of the first and second metatarsal heads, in addition to the first proximal phalanx, and potentially a lesser degree to the distal 1st phalanx. Findings concerning for acute osteomylelitis.

osseous erosion with subq emphysema. cellulitis/osteo

Gas locules in the soft tissues of the first phalanx. No bony erosion to suggest osteomyelitis. Joint spaces intact.

Moderate volume subcutaneous emphysema in the dorsal and plantar mid foot in the region of the 1st and 2nd metatarsal-phalangeal joint spaces. Concerning for gas-forming infection or necrotizing fasciitis. No osseus abnormalities.

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Large amount of soft tissue gas around the forefoot with forefoot ulceration concerning for acute emphysematous infection. No obvious erosions, but questionable osteopenia around the 1st and 2nd MCP joints. MRI could further evaluate.

Erosive changes of the lateral 1st Metatarsal and prox/disatl phalanx with gas overlying the dorsal foot soft tissues which is concerning for osteomyeltits.

Gas within the soft tissues of the forefoot, concerning for necrotizing infection.

No acute fracture or traumatic malalignment.

Extensive soft tissue gas about the distal/medial aspect of the foot, particularly the great and second toes, as well as the first and second metatarsal heads. These findings are concerning for necrotizing soft tissue infection. There is subtle loss of cortical detail but no large osseous erosion. MRI could further evaluate if there is high clinical concern for osteomyelitis.

Extensive subcutaneous emphysema within the medial forefoot concerning for necrotizing soft tissue infection. Possible osseous erosions along the medial aspect of the first digit, may represent acute osteomyelitis. MRI would be more sensitive.
No acute fracture or malalignment.

Osteomyelitis/septic arthritis
subcutaneous gas concerning for necrotizing infection.

Necrotizing soft tissue infection surounding the MTP joints, predominantly the first MTP. No definite osseous erosions.

gas, edema, erosion. c/f osteo./

Heterogeneity of the soft tissue about the first digit, with extensive Dorsal and planar extension. Concern for subcutaneous emphysema

Possible osteomyelitis of the first distal phalanx.

necrotizing infection

Extensive soft tissue swelling and subcutaneous gas centered around the heads and proximal phalanges of the first and second toes. Irregular cortical erosions at the medial aspect of the second metatarsal head, concerning for osteomyelitis. Further evaluation with MRI can be obtained if clinically indicated.
Degenerative changes of the midfoot. Plantar enthesophyte. No radiopaque foreign body.

cortical destruction with extensive soft tissue subcutaneous gas of the right foot predominantly between the first and second digits, highly suspicious for osteomyelitis.

Extensive subcutaneous emphysema in the soft tissues of the right forefoot along with cortical erosions most prominent in the medial 2nd metatarsal head. There is a skin ulcer on the plantar tissues adjacent to the subcutaneous emphysema. This is consistent with osteomyelitis. surgical consultation is recommended.

subcutaneous emphysema present along circumfrential forefoot likely cellulitis.
radioluceny of the distal 2nd and 3rd metatarsal concerning for osteomyelitis.

Soft tissue swelling and gas about the first toe concerning for cellulitis and possible osteomyelitis

osteo

Soft tissue gas about the 1st and 2nd digits without underlying osseous erosions. This finding is concerning for necrotizing fasciitis.

Soft tissue gas and swelling about the forefoot, centered around the great toe and second MTP. Erosive changes at the first through third MTPs as well as first PIP.

extensive soft tissue gas about the dorsal > plantar surfaces of the medial forefoot, concerning for soft tissue infection, possibly nec fasc. No definite underlying osteomyelitis, though MR is more sensitive.

Soft tissue defect concerning for ulcer at the plantar aspect of the first digit with significant subcutenous emphysema concerning for necortizing infection. Findings concerning for osteomyelitis at the first and second metatarsal heads.

Soft tissue swelling and edema over the dorsal aspect of the forefoot concerning for cellulitis. No overt evidence of bony destruction at this time but radiography is relatively insensitive for early osteomyelitis and MRI could be considered for further evaluation if clinically indicated.

Erosive changes along the lateral aspect of the first distal phalanx with extensive subcutaneous emphysema between the first and second phalanges. Findings are concerning for osteomyelitis.

Soft tissue swelling with subcutaneous emphysema about the forefoot with bony erosion of the great toe phalanges and head of the second metatarsal, suggestive of osteomyelitis. Recommend MRI for further evaluation.
Periarticular osteopenia.

Prominent soft tissue swelling and stranding around the first and 2nd digits. Questionable erosive changes at the head of the 2nd metatarsal head.

No acute fracture or dislocation.

Joints are maintained. There is osteopenic appearance of the forefoot.

There is subcutaneous emphysema in the fore foot, for which necrotizing soft tissue infection cannot be excluded.

nec fas

subq gas and boney errossions of the 1st and secondMTP

Soft tissue edema and gas at the base of the first digit, possible lytic changes at the head of the second metatarsal

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Extensive subcutaneous emphysema along the plantar and dorsal surface of the forefoot with possible bony destruction of the 1st distal phalanx, 1st proximal phalanx, and 1st and second distal MCP.