Presentation
History of chronic Right ankle pain.
Patient Data
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Plain radiograph shows a well circumscribed radiolucent expansile lesion in the center of the calcaneus bone with sclerotic borders. There is no cortical destruction.
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CT scan shows intraosseous well defined fat density lesion with sclerotic margins in the central area of calcaneal body. There are areas of high density inside the lesion that may represents hemorrhagic components.
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MRI sagittal view, different sequences show typical fatty appearance of calcaneal lipoma in the form of high signal intensity (SI) in both T1 and T2 and loss of SI in STIR protocols. The lesions inside the lipoma show different signal patterns with different protocols that represent different stages of intra-lesion hemorrhages or necrosis. By MRI with contrast, there is contrast uptake mainly surrounding hemorrhages/necrosis.
Case Discussion
This is a case of intraosseous lipoma of right calcaneal bone . It is composed of fat cells that replace the resorbed bone trebeculae. The former my undergoes degenerative process that ends up with cystic spaces and dystrophic calcifications inside the lipoma.
Stages of calcaneal lipoma :
Stage I : The lesion composed of lipocytes, similar to the cells of subcutaneous adipose tissue.
Stage II: Necrotic foci and foci of reactive osteogenesis are present.
Stage III: Advanced necrotic lesions with focal calcifications and cystic degeneration.
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