Radiology 101

Ever since I have known Nancy, she has randomly had a nagging pain in her right ankle. It would appear at random times and cause her a lot of discomfort. In fact, she has had this random recurring pain since college. Well recently it began hurting worse, so I checked it out to see if I could figure out what was wrong with it. We determined that the pain was confined to the medial malleolus of her right tibia (the knobby bone on the inner part of the ankle). It didn't seem to hurt to flex or extend the ankle, but it hurts when pressure is applied to that bone.

So, since I own an x-ray machine, we set out to x-ray her ankle to see if anything would show up. The first picture is the x-rays (2 views) of her right ankle. The next picture is of her non-painful left ankle on the left, and her painful right ankle on the right. For comparison purposes, the right picture is flipped so that the inner part of the ankle faces to the right in both pictures.

See anything?

After looking at the x-rays, I could definitely see a radiolucent (dark area) circular area, surrounded by sclerotic bone (whiter, denser bone) in the medial malleolus, which is where she is painful. This resembles a cystic bone lesion that some animals get, but since I went to veterinary medical school, and not Homo sapien medical school, we did some research. It turns out that this is a common place to develop bone cysts in teenagers and young adults. So that is what we think this is. Here are some pictures where I have labeled the cyst, since it is kind of hard to see.

She went to see an orthopedic surgeon on Thursday, and he is seeing the same cystic lesion. She didn't take her x-rays that I took with her, or even tell him about them, since it is technically illegal for me to "practice medicine" on a person. She now has to go have a contrast MRI done next week, to see if they will need to biopsy the cyst. Sometimes, they have to drill a hole into the cyst and put in a bone graft. So we'll see how it turns out. She is supposed to be on crutches to keep pressure off of it, but of course she isn't using them at all.

I know this has nothing to do with the house, but Nancy wanted me to post the pictures a) so her parents could see them, since she was telling them about it last night, and b) so that if any of you saw her limping or on crutches, she wouldn't have to try to explain why.

And I know I am a nerd, but this is alot more interesting than bricks and drywall.