Ankle and Foot 47 - Department of Radiology - University of ...

More documents

Recommendations

Info

2232 VII Imaging of the Musculoskeletal System Figure 47-34. Normal type 1 (small) accessory navicular (arrow in dashed magnified box). Figure 47-35. Normal type 2 (large) accessory navicular (white arrow in dashed magnified box). Incidentally seen is a normal os peroneum (black arrow). bone itself. Patients with this normal variation are typically asymptomatic unless they have a fracture through the normal fibrous union between the navicular and accessory navicular. A painful accessory navicular syndrome can be diagnosed by MRI by the presence of marrow edema in the accessory navicular and the adjacent navicular bone, especially if this corresponds to the point of maximum pain (Fig. 47-36). Normally, there should be a solid fibrous union between the type 2 accessory navicular and the navicular. The presence of a line of fluid between these bones is abnormal and indicates a pseudarthrosis, another MRI finding in accessory navicular syndrome (Fig. 47-37). • Os Peroneum Syndrome The os peroneum is a common sesamoid bone located in the peroneus longus tendon as it passes under the cuboid. In rare cases, this normal ossicle can become inflamed and painful. Chronic inflammation can be suspected radiographically if the os peroneum is abnormally sclerotic, although this finding is subjective. A more objective finding Ch047-A05375.indd 2232 9/9/2008 5:34:04 PM
A C E B D F Figure 47-36. Accessory navicular syndrome in a 20-year-old with focal pain directly over the left medial navicular. A, Standing anteroposterior radiograph of the asymptomatic right foot shows an elongated medial pole of an otherwise normal navicular (arrow). This has been referred to as a cornuate navicular and as a type 3 accessory navicular. B, Standing anteroposterior radiograph of the symptomatic left foot barely reveals the type 2 accessory navicular (arrow in the magnified dashed box). C, Far-medial sagittal T1-weighted image well shows the posterior tibial tendon (T) inserting onto the type 2 accessory navicular (A), as well as the fibrous union (arrowhead) between it and the navicular bone (N). D, Corresponding sagittal inversion recovery image shows subcortical edema (arrows) on both sides of this fibrous union. E, Oblique coronal T1-weighted image through the round head of the talus (Ta) shows the marker (m) indicating that the site of focal tenderness is directly over the abnormal articulation between the type 2 accessory navicular (A) and the navicular bone (N). F, Corresponding coronal T2-weighted fat-suppressed image shows subcortical edema (arrows) on both sides of this abnormal articulation. G, Oblique axial T1-weighted image shows that the marker (m) indicating the site of focal tenderness is directly over the abnormal articulation between the type 2 accessory navicular (A) and the navicular bone (N). H, Corresponding axial T2-weighted fat-suppressed image shows subcortical edema (arrows) on both sides of this abnormal articulation. G H Ch047-A05375.indd 2233 9/9/2008 5:34:06 PM
Page 1 and 2: Ken L. Schreibman Richard Bruce Ank
Page 3 and 4: 47 Ankle and Foot 2209 47 Figure 47
Page 5 and 6: 47 Ankle and Foot 2211 47 A B C Fig
Page 7 and 8: 47 Ankle and Foot 2213 47 A B C D E
Page 13 and 14: 47 Ankle and Foot 2219 47 A B Figur
Page 21 and 22: 47 Ankle and Foot 2227 47 J K L M N
Page 25: 47 Ankle and Foot 2231 47 A B Figur
Page 29 and 30: 47 Ankle and Foot 2235 47 A B Figur
Page 37 and 38: 47 Ankle and Foot 2243 47 A Ankle/d
Page 39 and 40: 47 Ankle and Foot 2245 47 A Figure
Page 41 and 42: 47 Ankle and Foot 2247 47 ankle ten
Page 49 and 50: 47 Ankle and Foot 2255 47 A B C D F
Page 53 and 54: A B 47 Ankle and Foot 2259 47 Figur
Page 55 and 56: 47 Ankle and Foot 2261 47 A C B D F
Page 57 and 58: A B 47 Ankle and Foot 2263 47 Figur
Page 63 and 64: • Calcaneal Fractures 6,18,33 47
Page 65 and 66: 47 Ankle and Foot 2271 47 H J I LPT
Page 67 and 68: 47 Ankle and Foot 2273 47 LPT N APC
Page 69 and 70: 47 Ankle and Foot 2275 47 E F G H F
Page 73 and 74: 47 Ankle and Foot 2279 47 F G H Fig
Page 77 and 78:
47 Ankle and Foot 2283 47 LEFT LEFT
Page 79 and 80:
47 Ankle and Foot 2285 47 A Figure
Page 81 and 82:
C D 47 Ankle and Foot 2287 47 Figur
Page 83 and 84:
47 Ankle and Foot 2289 47 Figure 47
Page 85 and 86:
47 Ankle and Foot 2291 47 D E F G F
Page 87 and 88:
A C B D 47 Ankle and Foot 2293 47 F
Page 89 and 90:
47 Ankle and Foot 2295 47 Tarsal tu
Page 91 and 92:
Page 93 and 94:
47 Ankle and Foot 2299 47 A B C D E
Page 95 and 96:
47 Ankle and Foot 2301 47 A B C Fig
Page 97 and 98:
Page 99 and 100:
47 Ankle and Foot 2305 47 A Figure
Page 101 and 102:
A B C 47 Ankle and Foot 2307 47 Fig
Page 103 and 104:
Page 105 and 106:
A B C D E T1 T2fs T1fs IVGd F G H F
Page 107 and 108:
Page 109 and 110:
A B 47 Ankle and Foot 2315 47 Figur
show all

Ankle and Foot 47 - Department of Radiology - University of ...

Create successful ePaper yourself

Delete template?

Save as template?