Spontaneous osteonecrosis at navicular bone

Case contributed by Dr Muhammad Shoyab

Presentation

Swelling of left foot, cough

Patient Data

Age: 70 years
Gender: Male
X-ray

X-Ray left foot

Lateral half of navicular bone is collapsed, producing comma-shaped appearance.

Small patches of lucent & sclerotic appearance are noted within trabecular space of lateral portion of navicular bone.

Osteophytes are noted at lateral articular surface of navicular.

Loose bodies are noted around 2nd metatarsophalangeal joint. However, joint space and aritcular margins are normal.

X-ray

Zoomed images of same x-ray

Lateral half of navicular bone is collapsed, producing comma-shaped appearance.

Small patches of lucent & sclerotic appearance are noted within trabecular space of lateral portion of navicular bone.

Osteophytes are noted at lateral articular surface of navicular.

Case Discussion

Spontaneous osteonecrosis (also knows as avascular or aseptic necrosis) of navicular bone is known as Mueller-Weiss disease in adults and Kohler disease in children.

Although pain is the most common presentation, it may gradually subside, as in the present case.

The disease often starts in the lateral aspect of the navicular, resulting in its typical comma-shaped appearance when the affected part (i.e. lateral) collapses. The other usual findings of osteonecrosis, namely, patchy sclerotic-lytic appearance, collapse, fragmentation, articular surface irregularity are also present.

Medial and/or superior and/or dorsal subluxation is also a typical feature of the disease, occurring due to pathological fracture with progress of the disease. No such subluxation has occurred in this case, which means that pathological fracture has not yet occurred.

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Case information

rID: 85225
Published: 28th Dec 2020
Last edited: 29th Dec 2020
Inclusion in quiz mode: Included

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