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Wk 9, Case 2, Foot/Ankle MR - Review

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Report

Patient History

45 F with firm immobile mass in tarsal tunnel region and pain x 3yr. On palpation pain radiating to foot and heel.

Findings

ARTICULATIONS:

Bone: Patchy heterogeneous feathery osteoedema throughout the distal tibial epiphysis and physis, talus and calcaneus.

Tibiotalar joint: No osteochondral defects or arthropathy.

Midfoot: Advanced osteoarthrosis and penetrating chondromalacia of the dorsal talonavicular joint.

LIGAMENTS:

Anterior inferior tibiofibular ligament: Intact.

Posterior inferior tibiofibular ligament: Intact.

Interosseous membrane and ligament: Intact.

Anterior talofibular ligament: Intact.

Posterior talofibular ligament: Intact.

Calcaneofibular ligament: Intact.

Deltoid ligament complex: Scarred without acute injuries.

TENDONS:

Peroneus Longus/Brevis: Intact.

Posterior Tibialis: Intact.

Flexor Compartment: Intact.

Extensor Compartment: Intact.

Achilles tendon: Mild insertional tendinosis with traction enthesopathy and nominal retrocalcaneal bursitis.

GENERAL:

Muscles: No traumatic muscle injury. No volumetric muscle atrophy.

Soft Tissue: Well-circumscribed oval-shaped low T1 with corresponding increased T2 signal homogeneously enhancing soft tissue mass measuring 1.4 cm x 1.4 cm x 2.1 cm (AP, transverse and CC) located within the tarsal tunnel anteriorly displacing the flexor tendons and posterior tibial artery.

Plantar Fascia: Mild thickening of the flexor digitorum brevis with small traction enthesophyte formation. No inflammation, tears or heel fat pad edema.

Joint Effusion: Small tibiotalar and posterior tibiotalar joint effusions, likely reactive.

Intra-Articular/Loose Bodies: None.

Impressions

1. A 1.4 cm x 1.4 cm x 2.1 cm homogeneously enhancing oval-shaped mass located within the tarsal tunnel anteriorly displacing the flexor tendons and posterior tibial artery favoring a nerve sheath tumor such as schwannoma or neurofibroma.

2. Patchy heterogeneous feathery osteoedema throughout the distal tibial epiphysis and physis, and hindfoot raising suspicion for complex regional pain syndrome type 2 (causalgia).

3. Small tibiotalar and posterior tibiotalar joint effusions, likely reactive.

4. Superomedial calcaneal haglund deformity and achilles insertional tendinopathy with traction spur.

Case Discussion

Faculty

Stephen J Pomeranz, MD

Chief Medical Officer, ProScan Imaging. Founder, MRI Online

ProScan Imaging

Gitanjali Bajaj, MD

Assistant Professor

University of Arkansas for Medical Sciences

Edward Smitaman, MD

Clinical Associate Professor

University of California San Diego

Brian Y. Chan, MD

Assistant Professor of Musculoskeletal Radiology

University of Utah

Tags

Musculoskeletal (MSK)

MRI

Foot & Ankle

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