Köhler disease

Case contributed by Dr Aditya Shetty

Presentation

Pain and swelling over foot for the last 3 months; no history of trauma

Patient Data

Age: 6 years
Gender: Male
X-ray
  • area of sclerosis noted within the navicular bone of left foot
MRI
  • navicular bone and head of talus appears hyperintense on STIR images
  • peripheral enhancement of navicular bone and enhancing areas at head of talus on T1C+
  • the enhanced areas are confirmed and better visualized on the SUBTRACTED images

Case Discussion

Case of osteonecrosis of the navicular bone of left foot.

Findings in favor of pathology:

  • male child of pediatric age group (4-6yrs)
  • suspicious areas of sclerosis on X-ray in the navicular and head of talus
  • STIR hyperintensity representing bone edema
  • no enhancement except for a peripheral rim of enhancement 

The peripheral enhancing areas probably represent areas of hyperemia due to granulation tissue formation and bone repair.

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