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9b - Answer: 11-year-old female presents with lump on third digit of right foot

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

HISTORY: 

This 11-year-old female presents with lump on third digit for more than 1 year, lump is moving with time, not growing any larger, no pain, no surgery, no injections, no cancer, not diabetic.

(QUIZ ANSWER) MOST LIKELY PRIMARY FINDING: 

Ganglion.

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

FINDINGS

SKELETAL: No fracture, stress fracture, or contusion. 

LIGAMENTS AND TENDONS: Visualized ligaments and tendons of the mid and forefoot without abnormality. No hypertrophic tendinosis, or acute tear. No turf toe with intact abductor hallucis tendon insertion on the medial sesamoid and medial capsule, transverse and oblique heads of the abductor hallucis muscle fibers intact and the lateral sesamoid capsule endplate. Medial and lateral heads of the flexor hallucis brevis demonstrate normal insertion onto the sesamoids plantar to the first MTP. 

MUSCLES: Intrinsic muscles of the toes are intact without hemorrhagic tear or strain. No muscle atrophy.  

JOINT SPACES: No evidence of active capsulitis or regional erosion. 

PLANTAR SOFT TISSUE/ SUBCUTANEOUS FAT: Pressure-related soft tissue thickening/fibrosis deep to the head of the 5th metatarsal. No perineural fibrosis or discrete Morton's neuroma. Trace fluid signal within the third intermetatarsal space demonstrated coronally.

Dominant 8.6 AP x 8.9mm craniocaudad x 12mm oblique AP diameter ganglion along the medial and dorsal margin PIP joint of the third toe. The lesion spares the DIP joint. No adjacent erosions or distortion of the pulleys or flexor tendons of the toe. 

PLANTAR PLATES: No sesamoiditis or AVN. First MTP articulation, to include the medial and lateral collateral ligaments and intersesamoid ligament: (intact). Medial and lateral dorsal main collateral and hammock like accessory sesamoid ligaments are not disrupted. Lesser plates without chronic or acute tear. 

CONCLUSION

1. 12 x 10mm ganglion versus epidermoid or cystic schwannoma PIP joint medial and plantar surface of the third toe. 

2. Otherwise, normal. 

3. Trace intermetatarsal bursal fluid in the third MT space.

LESSON 2, TOPIC 27

Case Challenge: Foot & Ankle MRI Cases

Case Challenge

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Content reviewed: August 31, 2021

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