Case report 555: Intraosseous ganglion cyst of the distal end of tibia.

Abstract

Skeletal Radiology Skeletal Radiol (1989) 18:385-388 Case report 555 David H. Dungan, B.S. 1, Leanne L. Seeger, M.D. 1, and Joseph M. Mirra, M.D. 2 Departments of 1 Radiological Sciences and 2 Pathology, U C L A School of Medicine, Los Angeles, California, USA Imaging studies Fig. 1. Anteroposterior radiograph of the left ankle. Lobulated subchondral lucencies are seen at the tibial plafond (arrows). The margins are well defined, faintly sclerotic, and the joint space appears normal Fig. 2. A Coronal spin echo image with relative Tl-weighting (TR = 800, TE = 20). Well circumscribed, low signal intensity lesion is seen in the subchondral region. Septation (arrow) is imaged as a line of signal void. Adjacent articular cartilage is normal. B, C Axial spin echo T2-weighted images (TR = 2000, TE = 80). Lesion shows regions of high signal intensity as well as foci of signal void (B). Thin line of high signal intensity appears to connect the lesion with the flexor tendon sheaths (C, arrowheads) Clinical information This 42-year-old woman sprained her left ankle 5 months previously and subsequently experienced persistent pain along the posterior aspect of her ankle. Her medical history was unremarkable ex- cept for a parathyroid adenoma which was excised two years earlier. Physical examination revealed moderate tenderness over the posterior aspect of the ankle with no swelling. Roentgenograms of the ankle demonstrated a lobulated lucency with sclerotic margins in the sub- chondral region of the distal end of the left tibia Address reprint requests to: L.L. Seeger, M.D., Department of Radiological Sciences, U C L A School of Medicine, 10833 La Conte, Los Angeles, CA 90024, USA (Fig. 1). No evidence of articular or soft tissue in- volvement was noted. Radionuclide bone scan showed increased uptake in the distal end of the tibia, with no other regions of abnormal uptake. Magnetic resonance images were obtained, demonstrating a sharply circumscribed lesion in the subchondral region of the distal end of the left tibia (Fig. 2). Except for septations, the lesion appeared as a homogeneous low signal intensity on Tl-weighted images. With T2-weighting, foci of very high signal intensity were intermixed with regions of signal void. A serpiginous line of high signal intensity was identified coursing between the lesion and the flexor tendons. Surgical excision of the lesion was performed. 9 1989 International Skeletal Society