Wk 5, Case 4 - Review

EXAM: Right Ankle radiographs (X-ray), 3 views

INDICATION: 14-year-old female with right ankle pain

TECHNIQUE: AP, medial oblique, and lateral views of the ankle were obtained

FINDINGS:
There is a vague 3 mm lucency along the mid talar dome. The exam is otherwise negative for acute fracture. The alignment is anatomic and the joint spaces are maintained. No joint effusion is present.

IMPRESSIONS:

Probable tiny 3 mm right talar dome osteochondral lesion. It may be helpful to obtain ankle MRI to further evaluate.

EXAM: MRI Right Ankle without contrast

INDICATION: 14-year-old female with right ankle pain and abnormal radiograph

TECHNIQUE: MR imaging of the right ankle was obtained without IV contrast. Routine protocol was utilized. Images were obtained in multiple planes.

FINDINGS:

The medial tendons, including the posterior tibialis, flexor digitorum longus, and flexor hallucis longus and intact. The ligaments, including the superficial and deep structures of the deltoid ligament complex intact. The spring ligament is intact.

The lateral tendons, including the peroneus longus tendon is intact. The peroneus brevis tendon is intact with expected mild flattening at the retromalleolar groove. The exam is negative for tenosynovitis. The peroneal retinaculum is intact. The ligaments, including the anterior inferior and posterior inferior tibiofibular (syndesmotic), are intact. The anterior talofibular ligament is intact. The calcaneofibular ligament is intact. The posterior talofibular ligament is intact.

At the posterior ankle, the Achilles tendon and plantar fascia are intact.

At the anterior ankle, the anterior tibialis, extensor hallucis longus, and the extensor digitorum longus tendons are intact.

The tibiotalar, subtalar, and midfoot joints appear unremarkable.

At the central talar dome, there is a 5.3 x 4.3 x 3.4 mm (AP x Trans x CC) osteochondral lesion. There is minimal linear subjacent bone marrow edema, without underlying T2 fluid signal intensity or significant subjacent cystic changes that would suggest instability. There is mild thinning and heterogeneity of the overlying cartilage. Remaining tibiotalar chondral surfaces are preserved. Negative for additional fracture. Remaining marrow signal intensity is normal for age.

There is a 4 x 6 x 10 mm T2 hyperintense cyst anterolateral to the talus. The remaining soft tissues appear unremarkable.

IMPRESSIONS:

1. Osteochondral lesion of the central talar dome (5.3 x 4.3 x 3.4mm). Negative for evidence of instability.
2. Small ganglion cyst anterolateral to the talus