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Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
Practice Cases
Week 1
6 topics, 11 min.
Practice Cases
Week 2
6 topics, 18 min.
Practice Cases
Week 3
6 topics, 27 min.
Practice Cases
Week 4
6 topics, 7 min.
Practice Cases
Week 5
6 topics, 45 min.
0:00
Images of a 62-year-old man who is
0:03
presenting with pain in the midfoot.
0:07
Sagittal T1, sagittal STIR, long axis
0:12
T2-weighted fat suppression on T1-weighted images.
0:17
We see changes in the marrow signal intensity
0:21
at the level of the distal second metatarsal,
0:25
which are confirmed on fluid-sensitive images
0:29
with the presence of extensive edematous changes.
0:35
The second metatarsal shaft, proximal and
0:38
distal, to an area where there is disruption
0:42
of the cortical hyperintense line, both,
0:46
dorsally and plantarly, on axial images.
0:51
There is a complete horizontal
0:54
linear focus traversing that second
0:58
metatarsal in the setting of
1:01
a stress fracture, complete stress fracture
1:05
without displacement of the second metatarsal.
1:09
So we are assessing for the presence of periosteal
1:13
reaction, soft tissue swelling, bone marrow
1:17
edema, and linear components traversing the cortex
1:22
in the setting of a complete stress fracture.
Wk 1, Case 4 - Review
HIDEInteractive Transcript
0:00
Images of a 62-year-old man who is
0:03
presenting with pain in the midfoot.
0:07
Sagittal T1, sagittal STIR, long axis
0:12
T2-weighted fat suppression on T1-weighted images.
0:17
We see changes in the marrow signal intensity
0:21
at the level of the distal second metatarsal,
0:25
which are confirmed on fluid-sensitive images
0:29
with the presence of extensive edematous changes.
0:35
The second metatarsal shaft, proximal and
0:38
distal, to an area where there is disruption
0:42
of the cortical hyperintense line, both,
0:46
dorsally and plantarly, on axial images.
0:51
There is a complete horizontal
0:54
linear focus traversing that second
0:58
metatarsal in the setting of
1:01
a stress fracture, complete stress fracture
1:05
without displacement of the second metatarsal.
1:09
So we are assessing for the presence of periosteal
1:13
reaction, soft tissue swelling, bone marrow
1:17
edema, and linear components traversing the cortex
1:22
in the setting of a complete stress fracture.
Report
Patient History
62-year-old man with pain in the right midfoot.
Findings
Skeletal/osseous:
Complete but nondisplaced transverse stress fracture of the distal shaft of the 2nd metatarsal, with associated circumferential fusiform periosteal reaction/callus formation. Low-grade Osteoedema surrounding the transverse fracture.
Mild to moderate hallux valgus deformity.
Flattened fibular and tibial sesamoid grooves and Crista.
Articulations:
Moderate-sized juxtacortical osseous erosion at the medial aspect of the 1st metatarsal head, adjacent to the medial collateral ligament insertion. Mild to moderate arthrosis with slight marginal osteophytic spurring and joint space loss.
Marked tibial/medial sesamoid phalangeal arthrosis with flattening/osseous remodeling of the sesamoid groove. Moderate to marked fibular/lateral sesamoid phalangeal arthrosis with flattening and remodeling of the sesamoid groove. Flattened remodeled Crista.
Lisfranc joint:
Intact.
Tendons:
Intact and unremarkable.
Ligaments:
Intact.
Plantar plates:
Chronically frayed fibular/lateral 1st plantar plate and sesamoid phalangeal ligament.
Soft tissues:
Diffuse soft tissue swelling and edema surrounding the 2nd metatarsal stress fracture.
Moderately thickened/scarred medial collateral ligament of the 1st metatarsophalangeal joint.
Incidental mild plantar perineural fibrosis between the 2nd and 3rd metatarsal heads. No bulky Morton neuroma. No intermetatarsal bursitis.
Other:
None.
Impressions
1. Transcortical stress fracture without displacement of the 2nd mid to distal metatarsal shaft with resultant periosteal reaction/callus and surrounding soft tissue swelling.
2. Marked tibial/ medial sesamoid phalangeal arthrosis. Moderate to marked fibula sesamoid phalangeal arthrosis. Osseous remodeling/flattening of the sesamoid grooves and Crista.
3. 1st metatarsal head juxtacortical osseous erosion. Thickened scarred medial collateral ligament.
Case Discussion
Faculty
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
ProScan Imaging
Todd D. Greenberg, MD
Radiologist
ProScan
Tags
Musculoskeletal (MSK)
MRI
Foot & Ankle
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