Hello everyone! Nice to meet you all. I was hoping you could help me with a case. I’d love to have your opinion.
It’s about a 22-year-old male patient who consults due to knee trauma. In the emergency, they perform an X-ray which they assume is "non-pathological", and discharge the patient with analgesia and request an ambulatory MRI.
In the initial MRI, bone edema of the external tibial plateau was detected, but also an epiphyseal central lesion of nodular morphology, indeterminate for me, for which I recommend completing the study with contrast and diffusion sequences.
The patient only returned after 2 months to complete the study (which at some point also gave a wider margin to assess changes). Unfortunately, it was done over the weekend, without medical supervision, so the sequences I have are what they are.
In contrast images, a predominantly central enhancement is observed, and the diffusion (b800-ADC) shows no restriction, even some central facilitated diffusion. There are not many epiphyseal lesions, however, I believe that it doesn’t have the radiological characteristics of any of them.
What is your opinion? Thank you all for cooperating!
Thank you all for your valuable opinions. I have compiled everyone’s responses, in case it is of interest to those who have participated.
Many of you thought, like me, if it could be related to an avulsion of the tibial spines, the reality is that the images do not show at least a significant avulsion, and generally the avulsions do not usually associate so much bone edema, and the morphology is not usually so rounded. Following the traumatic line, some proposed that it was a subchondral fracture, again I am not convinced by the “mass appearance.”
Some suggested the possibility of FOPE, but considering this is a 22-year-old patient, I think we should no longer see these types of images, or yes?.
An island of red bone marrow, due to its morphology and “matrix”, was really interesting, but it should not enhance with i.v. contrast. I’ve also been thinking about some type of major hematoma… I’ve tried to look for similar images, but the roundness of the lesion bothers me, as does the sclerosis in conventional radiology.
So, I am more inclined to think that it may be a lesion, as some have proposed chondroblastoma, or lymphoma (DWI not agree). At least I think I should leave the possibility that it’s not just something benign.
I am still not sure what I will say in the report. Yes, I am clear that I will request a CT scan. Hopefully, the patient will not return in 2 more months to have it done, and I hope he does not get lost in the middle.
If I have news I will let you know.
Thank you all again.