Intraosseous lipoma - cockade sign

Case contributed by Leonardo Lustosa
Diagnosis almost certain

Presentation

Pain on the plantar surface of the right foot when walking, especially on the first step of the day.

Patient Data

Age: 55 years
Gender: Female

Well-defined lytic lesion with central calcification (cockade sign) noted in the right calcaneum, no cortical disruption. Typical appearance of a calcaneal intraosseous lipoma.

Case Discussion

Intraosseous lipomas are relatively rare benign fatty tumors.

On plain radiographs, they are seen as well-defined lytic lesions, and a thin sclerotic rim may be noted. The lesion may present with either central necrosis or central calcification, the latter is known as a cockade image.

In the present case, the finding is likely to be incidental, as the clinical presentation is classic of plantar fasciitis.

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