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This is a 15-year-old boy who stubbed his big toe.

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Dr. P here.

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4 00:00:05,560 --> 00:00:07,979 So, what does wipeout mean?

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Wipeout means that we have completely lost

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the signal intensity, and, although not shown yet,

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we've lost the cortical anatomy,

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the cortical-medullary anatomy of a structure.

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Now the patient stubbed their toe,

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so your first question is,

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why could this not be just a fracture?

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And maybe it is.

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We'll keep drilling for the fracture,

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but as we go through the images,

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the T1 weighted image shows the entire distal tuft,

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a holo tuft signal replacement.

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It's completely gray.

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You know, we've got a white piggy,

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a white piggy, a white piggy,

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and then we have a completely gray piggy.

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Maybe with the exception of the

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very distal-most aspect of it.

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That is not a great pattern for a fracture.

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Usually, when you have edema around a fracture,

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the edema emanates from the fracture and it

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fades as you move away from the fracture.

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We did a fat-suppressed T1 weighted

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image, and then a fat-suppressed T1

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weighted image with contrast, and the

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great toe lights up like a Christmas tree.

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And that is also atypical for a fracture.

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You know, if there's a fracture,

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you'll see some reparative response around the

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fracture, some hyperemia next to the

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fracture, and then the enhancement will

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fade as you move away from the fracture.

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So now let's call up a series of T1 weighted

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images and see what we've got there.

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We indeed, we do have a fracture.

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But again, we do not have that fading

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phenomenon away from the fracture.

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The intensity of the edema remains the same.

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You completely waxed or wiped out the

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medullary signal, not as much of the

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cortical signal, although there is cortical

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signal loss at the site of the fracture.

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The toe was red and inflamed.

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So even though there isn't cortical wipeout,

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which there frequently is in osteomyelitis, there is an

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atypical pattern of medullary wipeout, or spongy bone,

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or endochondral bone wipeout that you should

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not see with a fracture which this patient has.

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So this is an example of stubbed

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toe fracture with osteomyelitis.

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And if we call up the short axis views,

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they are just as pretty and just as impressive.

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Let's take a look at them

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and scroll them together.

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And we've got

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you know, some nice white piggies over here,

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and then a gray piggy in the middle,

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some enhancement on the left, some high signal

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intensity on the right, and you can see some

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cortical loss along the dorsal surface of

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this toe, even where the fracture is not.

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Diagnosis, stubbed toe osteomyelitis

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with an underlying fracture.

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Let's move forward, shall we?

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Dr. P out.