10.7.19
Publication Date: 2019-10-07
4 images
Findings
Orthogonal radiographs of the right and left tarsi are available for interpretation.
Left tarsus: There is a large amount of extracapsular soft tissue swelling centered on the distal physis of the tibia, most severe on the medial aspect. The soft tissue swelling extends to the mid level of the proximal row of tarsal bones, including the region of the tarsocrural joint. There is marked osteolysis of the bone along the margins of the distal tibial physis, extending into the metaphysis and epiphysis, and widening of the physis, more so at the caudal aspect. There is irregular, amorphous periosteal proliferation along the caudal and medial aspect of the distal tibial metaphysis. There is a small focus of osseous proliferation on the dorsal aspect of the talus, at the margin of the described soft tissue swelling. The remainder of the tarsal joints are normal.
Right tarsus: There is a large amount of extracapsular soft tissue swelling centered on the distal physis of the tibia, more severe on the medial aspect. The soft tissue swelling extends to the mid level of the proximal row of tarsal bones, including the region of the tarsocrural joint. There is marked osteolysis of the bone along the margins of the distal tibial physis, extending into the metaphysis and epiphysis, and widening of the physis, most severe at the caudal aspect. There is irregular, amorphous periosteal proliferation along the caudal, dorsal and medial aspects of the distal tibial metaphysis. There is a small focus of osseous proliferation on the dorsal aspect of the talus, at the margin of the described soft tissue swelling. The remainder of the tarsal joints are normal.
Diagnosis
The osteolysis of the right and left distal tibial physes and associated periosteal proliferation and soft tissue swelling are most consistent with physitis and osteomyelitis. Given the location and bilateral nature, a hematogenous infection is considered most likely. Involvement of the tarsocrural joints (i.e. septic arthritis) is possible.
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