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hs/ke/nl/rg.

Name of the Patient : Abc Xyzslmn / M / 35 yrs.
Referred by : Dr. Abc Xyzrankar.
Examination : M.R.I. of the Right Tibio-fibular Joint.

CLINICAL PROFILE :

Operated cystic lesion upper 1/3 tibia on 00.00.00.
C/O pain in the right leg since 3 months.

EXAMINATION :

M.R.I. of the right tibio-fibular joint was performed using the following parameters :

6 mm thick T1 Weighted and STIR coronal images.

7 mm thick T1 Weighted and GRASS (with fat saturation) sagittal images.

6 mm thick T1 Weighted and T2 Weighted (with fat saturation) axial images.

OBSERVATION :

There is evidence of a mass lesion involving the upper one third of the right tibia with its superior aspect located at a distance of approximately 4.5 cms from the knee joint. The proximal metaphysis and upper diaphysis are also involved. This lesion is hypointense on the T1 Weighted images and turns heterogeneously hyperintense on the T2 Weighted, STIR and GRASS images. Hypointense areas on all pulse sequences are seen within the lesion and this may represent calcium/bone/fibrous tissue.





Also seen is destruction of the cortex of the tibia with soft tissue extension. A large soft tissue component is seen to extend in-between the tibia and fibula. It is seen to be displacing the muscles of the anterior component which are hyperintense on the T2 Weighted, STIR and GRASS images (? involvement by the lesion ? edema). Similar signal changes are also seen in the muscles of the lateral compartment as well as the popliteus, tibialis, posterior and soleus muscles. Also seen is posterior bulging of the intervening membrane.

The visualized fibula is unremarkable.

The lesion is also seen to extend upto the skin surface at the medial side of the tibia and this may be a result of previous operative intervention.

IMPRESSION :

The MRI features are suggestive of a mass lesion involving the upper one third of the right tibia with soft tissue extensions as described.

The differential diagnosis may include,

a. Aneurysmal bone cyst.

b. Chondrosarcoma.

c. Malignant Fibrous histiocytoma/Fibrosarcoma.

d. Small cell tumor.
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