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
3) Others?
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
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