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Os trigonum syndrome on bone SPECT/CT
Jianmin Huang1, Sabah Servaes, Hongming Zhuang
1From the *Department of Nuclear Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China; and †Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
A young athlete experienced lower leg pain, initially thought to be a stress fracture. Advanced imaging confirmed os trigonum syndrome, a condition affecting the ankle bone.
Area of Science:
- Sports Medicine
- Orthopedics
- Radiology
Background:
- Distal lower extremity pain is common in young athletes.
- Differential diagnoses include stress fractures and shin splints.
Observation:
- A 16-year-old female athlete presented with persistent left lower extremity pain.
- Initial assessment considered tibial stress injury.
Findings:
- Three-phase bone scintigraphy revealed subtle increased activity in the posterior left foot.
- SPECT/CT imaging precisely localized this activity to the os trigonum, confirming os trigonum syndrome.
Implications:
- Os trigonum syndrome should be considered in the differential diagnosis of posterior ankle pain in athletes.
- Advanced imaging like SPECT/CT is crucial for accurate diagnosis of accessory ossicles.
- This diagnosis impacts treatment and return-to-play protocols for athletic injuries.
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