Ankle Destructive Lesion-Teaching Discussion
13 yr old male with pain and swelling of the ankle for 3 months with no history of trauma. Teaching points by Dr MGK Murthy.
How to discuss the case and report
1) What is the Abnormality?
Grossly destructive, expansile, mixed signal intensity Talar lesion seen with cortical breach, MR demonstrable calcification, ossification with extensive soft tissue involvement with unremarkable joints and no encasing of tendons or vessels
2) How do we sum it up?
Radiologically aggressive osseous lesion .
In view of the age, Primary malignant neoplastic etiology is possible. Calcium suggests osteosarcoma and tumor like lesion -aneurysmal bone cyst are primarily differentials
Radiologically skeletal diagnosis contributes only 1/3 with clinical and Pathology other 2/3s
4) what are they ?
Aggressive infective etiology with chronicity including aggressive variety of Staphylococcal/Tuberculosis etc
5) How do we proceed ?
To start with X- ray would corroborate the calcium/ossification. Bone scan of F18 (fluorine variety) would give us the whole body CT with metabolite activity of the lesion
Lungs on CT would be doubly beneficial to suggest or exclude Infections, sequelae or metastatic foci
6) An USG/CT guided bx role???
Though highly tempting in view of approachable and apparently no risk, True cut biopsy could lead to severe local bleeding and adequate preparations should readily address the issues
7) Any other Radiology role ?
Presurgical embolization would be complementary in the management planning if necessary
Ankle Destructive Lesion-Teaching Discussion Reviewed by Sumer Sethi on Monday, October 06, 2014 Rating: