What is the underlying disease?

Sometimes the history can change everything when it comes to evaluating a case. I wanted to show you one such example. Before you look at my findings, be sure to come up with your own answer for what you think is this patient’s underlying disease.

Case History:

  • 74-year-old with swollen toe.
  • What is the underlying disease?
  • What is the underlying deformity?
  • What finding on MRI decides if the patient has osteomyelitis?



  • Underlying disease: Diabetes
  • Deformity: Bunion
  • “Erasure sign” or cortical loss on short axis T1 MRI (long arrow)
  • Infected bursitis (4 arrows) contiguous with bunion erosions (2 arrows) in the first metatarsal on MRI fat- and water-weighted imaging (images 2, 3, 4).
  • ProScan Pearl: It is common to see reactive marrow swelling on water-weighted MRI images but if the cortex is not lost on T1 MRI it is not osteomyelitis.

I’d love for you to check out more cases I’ve shared by taking a look at this complimentary course.

All the best,


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