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Age / Sex : 35 / F
Chief complaint: right medial foot pain 1) What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case.
(Quiz는 quiz일 뿐이오니 답안은 한개만 보내주시기 바라오며, 복수의 답안을 보내주시는 분은 정답이 포함되어 있더라도 부득이 semi-correct answer로 처리토록 하겠습니다.) Courtesy: 김완태(Wan Tae Kim), 중앙보훈병원(Veterans Health Service Medical Center)
Diagnosis: Nonosseous navicular-medial cuneiform coalition
Discussion
Findings:
Radiograph
shows a narrowed navicular-medial cuneiform joint space with irregularity and
sclerosis
MR
images show a low signal intensity fibrous coalition in the inferior part of
the navicular-medial cuneiform joint and joint space narrowing and cortical
irregularity.
Diagnosis: Nonosseous navicular-medial
cuneiform coalition
Discussion:
Tarsal coalition
represents abnormal bony fusion between two or more tarsal bones and is a
frequent cause of persistent foot pain. Naviculocuneiform coalition is a rare type of tarsal
coalition. Tarsal coalitions are further subclassified on the basis of the
tissue type of the abnormal bridging as either fibrous, cartilaginous, or
osseous. Miki et al.(1) noted that most navicular-medial cuneiform coalitions
consist of fibrous tissue with islands of chondroid tissue.
The
most common findings on plain radiography and CT were irregular articular surface,
subchondral sclerosis, subchondral cyst, beak-like spurs, and a narrowing of
the joint space. MRI is useful in diagnosing tarsal coalitions in the case of a
nonosseous union. In osseous coalitions, there is bone marrow contiguity across
the fused articulation. In nonosseous coalitions, the joint space is reduced.
In cartilaginous coalitions, an area of signal intensity similar to that of
fluid or cartilage may be present in the joint space. Intermediate- to
low-signal intensity in the affected joint may indicate a fibrous coalition.
Conservative
management should be pursued initially for symptomatic patients, followed by
surgical options for unresponsive cases.
References:
1. Miki T, Yamamuro T, Iida H, Ohta S, Oka M.
Naviculo-cuneiform coalition. A report of two cases. Clin Orthop Relat Res 1985:256-259
2. Akisue T, Yamamoto T, Marui T, Hitora T, Nagira K, Nakatani
T, et al. Bilateral naviculocuneiform coalitions: using multi-planar
reconstruction computed tomography. Orthopedics
2004;27:869-871
3. Ross JR, Dobbs MB. Isolated navicular-medial cuneiform
tarsal coalition revisited: a case report. J
Pediatr Orthop 2011;31:e85-88
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