0:00

Here we have a 69 year old with foot pain and medial ankle

0:06

swelling. So the key images or the saline findings in, in this,

0:11

uh, uh, patient's foot, we can see that, uh,

0:14

there's some non-specific marrow edema centered at the, uh, the midfoot.

0:19

But notice how the edema Okay. Has a sort of, um,

0:24

uh, what's been likened to a picture frame or,

0:26

or window framing sort of appearance. Okay. Centered mostly. Okay.

0:32

Probably along eccentrically better, probably a better term, uh,

0:35

along the cortices of the, uh, uh, tarsal bones of the, uh,

0:40

midfoot here. Okay.

0:42

Other pertinent findings are gonna be this non-specific soft tissue edema.

0:47

Okay? So this, uh, given this pattern and, and, uh,

0:52

you know, something to think about would be, uh, complex regional pain syndrome,

0:56

which turned out to be this diagnosis. Okay. Also known as, uh,

1:01

RSD or reflex, uh, sympathetic dystrophy, also known as, uh,

1:06

sude, uh, um, uh, atrophy or, or sude, uh, uh, disease.

1:12

Okay? And, and we can, if you read the literature, it can,

1:15

it can be divided into, um, two major types. Okay? Um,

1:20

but, uh, you know, you,

1:24

whether you have a nerve lesion or not, if you have a nerve lesion,

1:27

then you're gonna call it causalgia. Okay?

1:30

But the important thing here is to note that, uh, you have this, uh,

1:34

really this nice, uh, picture frame or,

1:38

or window framing appearance to the marrow edema, okay? And the,

1:42

and I also like to see soft tissue, uh, uh, surrounding soft tissue edema.

1:47

Okay? Uh, typically, uh, uh, more robust, uh, uh, as,

1:52

or can be robust as in this case, or even more robust.

1:56

But that's something to think about. The differential for this, uh, obviously,

2:01

you know,

2:01

it's gonna be stress changes looking for a fracture and things like that.

2:05

But as we know, uh, complex, uh, regional pain syndrome is typically, um,

2:11

uh, a disease where basically, um, I,

2:15

as I understand it in last, reviewed the literature, it, it's basically, uh, um,

2:20

a body's, uh, overreaction okay. Uh,

2:24

to a seemingly innocuous stimulus. Okay? Um,

2:28

and basically our autonomic system goes into overdrive. And,

2:33

uh, patients have, uh, um, this pain that typically is,

2:38

is out of proportion to what one would expect for the degree of inciting injury,

2:43

or, uh, the better medical term would probably be allodia. Uh,

2:47

the differential for this, particularly in the kids, just to be aware of,

2:51

in kids, as we know. Uh, typically you're gonna be active,

2:55

so you're gonna see patchy marrow edema in kids

2:58

All the time, and it's, uh, often seen, but asymptomatic bind in kids.

3:03

But that mar edema is typically, uh,

3:05

gonna be more central or intramedullary in location. Okay?

3:10

Um, so that's something to, uh, just to be aware about. Okay. And,

3:15

um, but this, uh, just a nice case of, uh,

3:19

CRPS.