Navicular Accessory Joint

The characteristic radiographic features of osteoarthritis of the navicular accessory bone include irregular narrowing of the navicular and navicular-accessory synchondrosis or joint with the condensation of the accessory bone, mimicking avascular necrosis (Fig. 9.50A). The accessory bone avidly accumulates tracer, attesting to the fact that dense accessory bone is not due to necrosis but stimulated bone

Sesamoid Tangential Ray

Fig. 9.48A, B Osteoarthritis in the "sesamoidal articulation" of the first metatarsal head. A Tangential radiograph (Lewis' view) of the plantar aspect of the painful right great toe in a 42-year-old woman shows minimal periarticular sclerosis and narrowing of the articulation formed between the medial sesamoid and the first metatarsal head (arrowheads). B Dorsal pinhole scan distinctly shows increased tracer uptake in the "enlarged" medial sesamoid (arrow) and the bones about the first metatar-sophalangeal joint. Caution must be exercised not to over-read physiologically increased tracer uptake in the metatarsal sesamoids (Fig. 4.39)

Fig. 9.48A, B Osteoarthritis in the "sesamoidal articulation" of the first metatarsal head. A Tangential radiograph (Lewis' view) of the plantar aspect of the painful right great toe in a 42-year-old woman shows minimal periarticular sclerosis and narrowing of the articulation formed between the medial sesamoid and the first metatarsal head (arrowheads). B Dorsal pinhole scan distinctly shows increased tracer uptake in the "enlarged" medial sesamoid (arrow) and the bones about the first metatar-sophalangeal joint. Caution must be exercised not to over-read physiologically increased tracer uptake in the metatarsal sesamoids (Fig. 4.39)

Fig. 9.49A-C Nuclear angiography in sesamoiditis. A Tangential view radiograph of painful left first metatarsal head sesamoids in a 35-year-old male shows mild sclerosis of the medial sesamoid bone (arrow). B Angiogram reveals increased blood flow and blood pool in the area in question (arrowheads). C Static planar bone scintigraphy shows tracer intensely accumulated in the medial sesa-moid bone denoting degenerative sesamoiditis (arrow)

Bone Scan Foot And Tibia Hot Spots
Fig. 9.51 Medial planar bone scan of both feet in a 31-year-old female incidentally shows tracer accumulated in navicular accessory bones that were symptomless
Scintigraphy Accessory Navicular

Fig. 9.50A, B Osteoarthritis of the navicular accessory joint. A Conventional X-ray tomogram of the right midfoot clearly demonstrates the condensed navicular accessory bone with articular formation (arrow). B Lateral bone scan of both feet reveals intense tracer uptake in pathological navicular accessory bone on the right (arrow). The tracer uptake seen in both retrocalcaneal surfaces and left posterior tibial malleolus are likely due to trauma in this sportswoman

Fig. 9.50A, B Osteoarthritis of the navicular accessory joint. A Conventional X-ray tomogram of the right midfoot clearly demonstrates the condensed navicular accessory bone with articular formation (arrow). B Lateral bone scan of both feet reveals intense tracer uptake in pathological navicular accessory bone on the right (arrow). The tracer uptake seen in both retrocalcaneal surfaces and left posterior tibial malleolus are likely due to trauma in this sportswoman formation. Multiple "hot" areas may be seen in the neighboring or contralateral foot bones and joints in adolescents, athletes in particular, suggesting concurrent trauma. The occurrence of the navicular accessory bone is bilateral in occasional cases (Lawson et al. 1984) and if symptomatic accumulates tracer. Our recent study of 200 consecutive cases comprising 92 men and 108 women with ages ranging from 20 to 68 years showed the incidence of bilateral and unilateral "hot" navicular accessory bones to be 0.5% and 3.5%, respectively, without gender predilection (Fig. 9.51).

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