Case Challenge

Foot & Ankle

Stephen J Pomeranz

Gain confidence interpreting Foot & Ankle MRI Cases with MRI Online. Quiz yourself using real-world, interactive scrollable cases & earn CME. Try it free!

Case Review

Musculoskeletal (MSK)

Post-Course Activities

This Power Pack is comprised of 25 unique Foot / Ankle MRI cases that you can scroll through in our diagnostic web viewer to determine your findings. Quiz yourself and earn CME.

Foot & Ankle MRI Cases

Case 16 - 76-year-old male presents with infection in the right foot

<div>HISTORY:&#160;This 76-year-old male presents with infection in the right foot with 3rd toe amputated, pain and possible infection in the 2nd toe.(QUIZ ANSWER) PRIMARY FINDING:&#160;Invasive osteomyelitis involving the distal phalanx of the 2nd digit.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS: Marked T1 hypointense signal involves the distal phalanx of the 2nd digit with associated marked bone marrow edema which extends to the distal interphalangeal joint consistent with "vanishing toe sign" and invasive osteomyelitis. In addition, associated marked surrounding soft tissue swelling and soft tissue edema.When compared to previous MR right foot, patient is post remote resection of the distal 3rd metatarsal with the proximal phalanx of the 3rd digit displaced laterally.&#160;Diffuse muscle atrophy.&#160;Diffuse swelling and capsulitis.&#160;Marked tenosynovitis with synovial hyperplasia of the extensor tendon.&#160;Massive callus along the metatarsophalangeal joints.&#160;CONCLUSION:1. Invasive osteomyelitis distal phalanx 2nd digit extending to the distal interphalangeal joint with extensive surrounding soft tissue swelling and edema.&#160;2. Diffuse extensive capsulitis and swelling as well as marked tenosynovitis along the 1st extensor tendon with synovial hypertrophy.&#160;3. Third transmetatarsal amputation.&#160;Medial dislocation of 4th proximal phalanx with respect to 4th metatarsal.4. Pressure lesion without ulceration beneath 5 metatarsal head.</div>

Case

Invasive osteomyelitis involving the distal phalanx of the 2nd digit

Primary bone neoplasm (i.Osteosarcoma) involving the distal phalanx of the 2nd digit

Langerhans cell histiocytosis (LCH) involving the distal phalanx of the 2nd digit

What is the primary finding in this case?