Male 85 years old Reason: 85 yo M with chondrocalcinosis with worsening pain in R ankle/foot; evaluate for ligament/tendon tear/inflammation, soft tissue swelling History: pain, difficulty with ambulation needing wheelchair. TENDONS: A small amount of fluid within the sheaths of the posterior tibial and flexor digitorum tendons is within normal limits. There is fluid within the flexor hallucis longus tendon sheath just proximal to the knot of Henry which may represent mild tenosynovitis. A small amount of fluid in the peroneal tendon sheaths is within normal limits. Increased signal intensity within the peroneus brevis tendon as it courses beneath the fibular tip likely represents mild tendinosis. The Achilles' tendon appears normal.LIGAMENTS: The lateral collateral ligament complex is intact. The distal tibiofibular syndesmotic complex is intact. The deep fibers of the deltoid ligament have lost their normal striations and there is an ossicle distal to the medial malleolus. These findings suggest old trauma. The superficial components of the deltoid ligament appear unusually thickened which may likewise reflect old injury.ARTICULAR SURFACES AND BONE: There is edema within the distal tibia that extends from the epiphysis into the distal diaphysis, off the field of view of this study. The signal abnormality is most concentrated along the anterolateral aspect of the distal tibial epiphysis and appears associated with a thin band of horizontally oriented low signal intensity immediately adjacent to the physeal scar. We suspect that this constellation of findings represents a stress fracture with edema extending into the distal tibial diaphysis. Additional foci of signal abnormality within the foot are likely degenerative in etiology reflecting mild osteoarthritis. Metallic artifact within the head and neck of the first metatarsophalangeal joint represents arthroplasty which is incompletely imaged on this study. The ankle joint itself appears normal with no joint effusion. We see no osteochondral defects.ADDITIONAL
1. Bone marrow edema in the distal tibia as described above. This appears most concentrated along the lateral aspect of the distal tibial epiphysis and is associated with a small linear focus of low signal intensity that we suspect represents a stress fracture.2. Fluid within the flexor hallucis longus tendon sheath proximal to the knot of Henry may represent tenosynovitis.3. Generalized soft tissue swelling.4. Other findings as described above.Findings discussed by myself Dr. Ward with Dr Siddiqui 5:35 p.m.. 04/17/15. 