This is a consult from my colleague, Michael Setton…we’re both hoping you can help with the diagnosis.
This is a referral from podiatrist whose stated indication is to evaluate osteoporosis, so….not useful at all.The patient told the tech that her ankle has been "abnormal since childhood" with chronic, worsening pain.
There is diffuse dark signal thickening of the achilles, I don’t know if she had previous achilles surgery…I also don’t know if that is where her pain is now or has been since childhood.
There are these multifocal sclerotic and cyst-like lesions of the distal fibula and of the tarsal and metatarsals of the middle and lateral column.
The outside XRs, screenshots shared by phone from the referrer (they were actually green, I recolored them) mirror what we see on MRI.
This was done without and with contrast.
The bright PDFS foci are bright on pre contrast T1FS images and don’t appear to enhance.
The distribution made us think of melorheostosis, but that doesn’t explain the bright, cystlike foci.
It looks alot like Pagets…she’s 45 now….I have no idea when she developed the bone lesions….but I’ve been seeing alot less Pagets since way back when, and I would be surprised.
I wondered if it could be something like cystic angiomatosis or hemangiomatosis of bone.
I really hope someone knows what this is.
Thank you.
Hilary
