To emphasize and understand the role of MR ankle arthrography as a problem solving tool in the differential diagnosis of challenging clinical cases.

A 44 years' old female patient presented with swelling and discomfort behind the lateral malleolus. There was no history of trauma. On examination, the patient presented with a relatively mobile, small but hard mass behind the lateral malleolus. There was minimal discomfort on walking but no true pain. No further such swelling was detected elsewhere in the body. No constitutional signs were present. The differential diagnosis was wide and included soft tissue/ tendon sheath tumors, loose bodies, distrophic calcification. As an initial examination, an x-ray...

The plain film demonstrated the presence of calcific deposits behind the lateral malleolus and initially a diagnosis of loose bodies in the ankle joint was made. The Orthopaedic Surgeon asked for an MSK Radiologist opinion. The unusual location of the calcific deposits, lack of locking and absence of osteochondral defects in the ankle raised doubts about the diagnosis of loose bodies in the ankle joint. It was felt an MR examination would be helpful prior to arthroscopic surgery. The MSK Radiologists recommended MR arthrography for...

MR ankle arthrography is an excellent problem solving tool in elucidating difficult diagnostic dilemmas and can help streamline the patient pathway.

1)MR arthrography of the ankle: indications and technique L Cerezal - ‎2008 et allRadiol Clinic North Am. 2008 Nov; 46(6): 973-94, v.doi 10.1016/j.rcl.2008.09002

Mr M. Williamson is Registrar in Trauma&Orthopaedics at Darent Valley Hospital NHS Trust Dartford Kent UK Mr H. MIn Hui is Registrar in Trauma&Orthopaedics at Darent Valley Hospital NHS Trust Dartford Kent UK Mr K. Chettiar is Consultant in Trauma&Orthopaedics at Darent Valley Hospital NHS Trust Dartford Kent UK Dr G. Constantinescu is Consultant MSK Radiologist at Darent Valley Hospital NHS Trust Dartford Kent UK Dr B. Bhattacharjee is Consultant MSK Radiologist at Darent Valley Hospital NHS Trust Dartford Kent UK