Zidani Hichem, Genah Idan, Lae Marick, Bousson Valerie, Laredo Jean-Denis
Department of Radiology, Hôpital Lariboisière, Assistance Publique des Hôpitaux de Paris, Paris, France.
Department of pathological anatomy and cytology, Institut Curie, Paris, France.
J Radiol Case Rep. 2020 Feb 29;14(2):12-20. doi: 10.3941/jrcr.v14i2.3711. eCollection 2020 Feb.
Adventitious bursitis of the plantar fat pad is a common cause of forefoot pain. It may develop at sites where subcutaneous tissue is exposed to friction and high pressure. In the forefoot, adventitious bursitis is usually adjacent to bony prominences of the metatarsal heads. Diagnosis and management of adventitious bursitis usually do not require imaging studies. However, the condition occasionally presents as a solid pseudotumoral mass requiring imaging. Magnetic resonance imaging (MRI) may demonstrate a heterogeneous mass with a solid component exhibiting intermediate to high signal intensity on T2-weighted images and thick nodular enhancement suggesting a neoplastic lesion. We report three cases of adventitious bursitis in patients who complained of a painful palpable mass on the forefoot, with a partially solid and enhancing component seen on MRI. In the first case, a biopsy was performed for the diagnosis of adventitious bursitis. The two other cases exhibited a solid component on MRI. However, a diagnosis of adventitious bursitis was suspected, and it was felt that a biopsy could be postponed. The spontaneous regression of the mass with relative discharge of the forefoot pressure confirmed the diagnosis. With these three cases, we illustrate the MR findings that could suggest adventitious bursitis despite the presence of a solid component and that may obviate the need for pathologic proof.
足底脂肪垫的创伤性滑囊炎是前足疼痛的常见原因。它可能在皮下组织受到摩擦和高压的部位发生。在前足，创伤性滑囊炎通常与跖骨头的骨性突出相邻。创伤性滑囊炎的诊断和治疗通常不需要影像学检查。然而，这种情况偶尔会表现为实性假瘤样肿块，需要进行影像学检查。磁共振成像（MRI）可能显示一个异质性肿块，其实性成分在T2加权图像上表现为中等至高信号强度，并有厚的结节状强化，提示为肿瘤性病变。我们报告了3例创伤性滑囊炎患者，他们均主诉前足有疼痛性可触及肿块，MRI显示有部分实性且强化的成分。在第一例中，进行了活检以诊断创伤性滑囊炎。另外两例在MRI上显示有实性成分。然而，怀疑为创伤性滑囊炎，认为可以推迟活检。肿块自发消退且前足压力相对减轻证实了诊断。通过这3例病例，我们阐述了即使存在实性成分也可能提示创伤性滑囊炎的MRI表现，且可能无需病理证实。
