A 20 year old female patient presented to our OPD with
complaints of pain in her left foot since about 10 months and
swelling in her left foot since 3 months.
Patient was apparently asymptomatic 10 months back when she developed pain in her foot which is insiduos in onset, of dull aching in nature, aggravated by standing and walking, and relieved by taking rest and/or medication. Pain is of increasing severity and is continuous since last 2 months.
Patient developed swelling in her left foot about 3 months back initially diffuse and gradually localized to mid dorsum of foot. There is no history of increase in the size of the swelling.
No h/o trauma
No h/o fever/ weight loss / constitutional symtoms.
No h/o numbness or paraesthesias in the foot.
No h/o similar complaints i the past.
No h/o TB/ DM/ HTN/ Asthma/ epilepsy/ bleeding disorders.
No h/o past hospitalisation/ surgery
Sleep disturbed of late due to pain
No h/o similar complaints in family members.
No h/o any tuberculous contact.
20 yr old female who is c/c/c, moderately built and nourished.with pallor,and is without icterus, cyanosis, clubbing, generalized lymphadenopathy, and pedal edema.
other systems normal
Local examination of her left foot
Local warmth noted,
Deep tenderness noted over the cuneiform bones and the bases over first second third metatarsal.
Swelling site and size are confirmed,skin over the swelling is pinch able and the swelling is uniformly soft in consistency fluctuant , margins well defined and has minimal mobility in AP and lateral directions. No translucency, neither reducible nor compressible.
Workup and radio graphs attached
MR will be attached shortly
9 months old x rays
Present X rays
Histopathology report of Open biopsy attached
Aspiration yielded straw colored thin fluid which was sterile on microscopy and culture
Open biopsy yielded bits of cheesy material and bony spicules of medial and middle cunieform bones.
What is your clinical radio logical and final diagnosis
how would you like to further manage this patient?