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4b - Answer: 58-year-old male with right ankle pain

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY

This 58-year-old male presents with right ankle pain.

(QUIZ ANSWER) PRIMARY FINDING: 

Haglund deformity.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS:

Hypertrophic Achilles tendinopathy with foci of mid substance interstitial microtearing is noted punctuated by enthesopathic insertional footprint tear:  

a. Superior posteromedial sharp-edged Haglund deformity.  

b. Supracalcaneal undersurface fraying-type tear and active inflammation with supracalcaneal secondary bursitis.  

c. Peeling of the mid to inferior footprint in the retrocalcaneal region.  

d. Traction enthesopathic erosion and stress reaction.  

e. Kager's space swelling.  

f. Consider superimposed secondary CPPD or crystalline deposition due to the chronicity and extent of inflammation.  

Due to altered mechanics of weightbearing, inferolateral subtalar bursal cyst so-called "stem ligament cyst" projecting dorsolaterally.  

Ankle joint unremarkable.  

Sinus tarsi ligaments normal.  

Ankle ligaments normal although the stem ligament bursal cyst sits directly atop the anterior talofibular ligament.  

Medial tendon group normal.  

Lateral tendon group normal.  

Anterior tendon group normal.  

Skeleton normal with type 2 accessory navicular identified. This, with the exception of the enthesopathic changes and Haglund deformity of the calcaneus.  

Plantar fascia normal.  

CONCLUSION:  

Multifocal areas of interstitial microtearing of the Achilles punctuated by prominent Haglund deformity and undersurface fraying-type tear whose depth is approximately 20% or less of a hypertrophic tendon. Subtle peel phenomenon of the mid to inferior footprint with enthesopathic calcaneal erosions and sharp-edged pump-bump.

LESSON 2, TOPIC 12

Case Challenge: Foot & Ankle MRI Cases

Case Challenge

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Content reviewed: August 31, 2021

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