Presentation
Ulcer over the posterior ankle.
Patient Data
Extensive subcutaneous edema around the ankle. Cutaneous defect posteriorly with the Achilles tendon immediately deep. Achilles paratenon high T2 signal thickening with enhancement, however, the Achilles tendon demonstrates its usual low signal. No retrocalcaneal bursal effusion.
Diffuse subcutaneous tissue enhancement reflecting cellulitis, including Kager's fat pad. Deep to the ulcer is a non-enhancing region reflecting necrotizing cellulitis. No fluid collection/abscess.
No bone marrow edema to suggest osteomyelitis.
Case Discussion
Extensive cellulitis centered on a posterior ankle ulcer with a small region of necrotizing cellulitis deep to the ulcer and distal Achilles paratenonitis. An infective Buruli ulcer (Mycobacterium ulcerans) was suspected clinically but no pathological confirmation was available.
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