Ankle Pain In A 31-Year-Old Man

A 31-year-old man presented with persistent right ankle pain and swelling of several months’ duration after a motor vehicle accident. There was no history of fevers, night sweats, or weight loss. The patient demonstrated severe restriction in range of motion and swelling of the ankle. Sensation was normal and no motor deficits were noted. There was mild tenderness along the anteromedial and anterolateral aspects of the tibiotalar and talonavicular joints. Plain radiographs (Fig 1), bone scan (Fig 2), computed tomography (CT) (Fig 3), and magnetic resonance imaging (MRI) (Fig 4) were performed. Based on the history, physical findings, and imaging studies, what is the differential diagnosis? From the Departments of Radiology, Orthopedic Surgery, and Pathology, New York University, Hospital for Joint Diseases, New York, NY. Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his or her institution has approved or waived approval for the reporting of this case and that all investigations were conducted in conformity with ethical principles or research. Correspondence to: Deep S. Chatha, MD, Department of Radiology, New York University, Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003. Phone: 212-598-6643; Fax: 212-598-6125; E-mail: cathad01@popmail.med.nyu.edu. DOI: 10.1097/BLO.0b013e3180533b84 CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Number 465, pp. 271–276 © 2007 Lippincott Williams & Wilkins