20 year-old female with edema and pain at multiple regions. Evaluate for Lisfranc injury, fifth metatarsal and lateral ligaments. There is edema within the dorsal subcutaneous fat of the forefoot and midfoot extending into the dorsal/lateral ankle where it appears to become confluent and be associated with high signal on T1 weighted images, indicating ankle hematoma. Although the ankle is not visualized in its entirety, the PTaFL appears intact. The calcaneofibular ligament appears thickened, which may represent sprain. We do not clearly visualize the ATaFL and suspect a tear. The anterior tibiofibular ligament is not well seen, possibly due to the obliquity of the acquired images. Edema within the deep fibers of the deltoid ligament may represent a sprain. There is a small tibiotalar joint effusion.There is a fracture of the base of the fifth metatarsal, extending to the tarsometatarsal joint with fragments in near anatomic alignment. Edema within the plantar aspect of the base of the fourth metatarsal and third metatarsal may represent contusions as we see no discrete fracture lines. A focus of edema within the medial base of the first metatarsal likewise may represent a contusion as we see no distinct fracture line. The Lisfranc ligament itself appears intact. The bone marrow signal of the cuneiforms and navicular is within normal limits. Edema within the anterior cuboid may represent a contusion as we see no fracture line. Edema most concentrated within the medial head of the talus may represent a contusion although we cannot exclude a nondisplaced surface fracture. The bone marrow signal of the distal metatarsals and phalanges is within normal limits. The fourth toe is absent, presumably due to amputation.
1. Although an ankle MRI exam was ordered, MRI of the forefoot and midfoot was performed, which does not include the ligaments of the ankle in their entirety. We will have the patient return for dedicated ankle MRI exam and will not charge for this forefoot/midfoot examination.2. Nondisplaced fracture of the base of the fifth metatarsal with additional foci of edema within multiple bones which may represent contusions, as described above.3. Hematoma along the lateral ankle with poor visualization of the ATaFL, which could be further evaluated if the patient returns for dedicated ankle MRI.