Male 21 years old with history of fibula Ewings with pulmonary metastases status post resection and radiation. Now with c/o great toe pain and swelling over lower leg. VIEWS: Right first toe oblique and lateral (2 views) 5/26/2015 at 11:08Right foot AP, oblique, and lateral (3 views) 5/26/2015Right tibia/fibula AP and lateral (2 views) 5/26/2015 Chest PA and lateral 5/26/2015 Right tibia/fibula: Postoperative changes of proximal fibular resection are seen with a metallic density projecting posterior to the fibula at the resection site. A small remnant of fibular head is present. Minimal irregularity of the mid fibula near the surgical clips, this may be related to postsurgical change but attention to this area on subsequent follow-up is recommended. Periosteal reaction is seen on the AP view along the lateral aspect of the remaining fibula. This may be related to prior radiation but correlation with previous imaging or further evaluation with MRI is recommended to exclude recurrence or second primary in this location.Right foot and right great toe: The bones are normal. No soft tissue swelling or evidence of fracture.Chest: Postoperative changes are again seen in the right upper and lower lobes. The cardiomediastinal silhouette is normal. There is no focal pulmonary opacity, pleural effusion, or pneumothorax.
1.Periosteal reaction along the lateral aspect of the remaining fibula. This may be related to prior radiation but correlation with previous imaging or further evaluation with MRI is recommended to exclude recurrence or second primary in this location.2.Minimal irregularity of the mid fibula at the resection site may be postsurgical but attention to this area on subsequent follow-up is recommended.Findings were discussed via phone with Dr. Drum at the time of this dictation.