PMC6885189_01
Osteosarcoma of the right calcaneus. (a) Lateral radiographs of the ankle. (b) CT scan of the right foot (sagittal). (c) MRI T1 FSE sagittal.
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Plain radiographs of the ankle and the foot revealed an ossification of the calcaneus (Figure 1(a)). The presence of a tumor was confirmed by a CT scan (Figure 1(b)) and a MRI (Figure 1(c)).
Surveillance of the tumor of the right calcaneus. (a) Initial anteroposterior radiograph of the pelvis. (b) TEP scan of the right calcaneus (SUVmax 7), upper metaphysis of the femur (SUVmax 2.8), and right sacroiliac (SUVmax 1.9). (c) Bone scintigraphy: intense hyperfixation of the right calcaneus, moderate hyper fixation of the lesser trochanter, and low fixation of the right sacroiliac articulation.
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On the PET scan, three different hypermetabolic lesions were seen: one intense hyper fixation of the right calcaneus (maximum of standardized uptake values SUVmax 7), one moderate hyperfixation of the upper metaphysis of the femur (SUVmax 2.8), and one low hyperfixation of the right sacroiliac (SUVmax 1.9) (Figure 2(a)). These results were confirmed by scintigraphy (Figure 2(b)). Based on the radiological aspect and low FDG uptake, the two lesions incidentally discovered were diagnosed as osteochondromas (Figure 2(c)).
Lateral (a) and anteroposterior (b) radiographs of the right calcaneus. Postoperative result at 3 months of the resection of the right calcaneus with a reconstruction by iliac graft along with a triple arthrodesis of the hindfoot.
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A resection of the right calcaneus with a reconstruction by iliac graft along with a triple arthrodesis of the hindfoot was performed (Figures 3(a) and 3(b)).
Lesions of the right sacroiliac and of the lesser trochanter: (a) aspect on CT scan and (b) aspect on MRI T1 Gado FAT SAT.
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CT and MRI performed 7 months after the end of chemotherapy showed only a thickening of the femur tumor's cap while the aspect of the sacroiliac lesion stayed stable (Figures 4(a) and 4(b)).
Postoperative imaging of the proximal left femur and of the right sacroiliac joint: (a) standard anteroposterior radiographs and (b) coronal CT scan.
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The surgery of the proximal left femur, performed 2 years after the discovery of the lesions, was a resection of the left proximal femur with a reconstruction by allograft and fibula autograft (Figure 5(a)). The sacral vertebras were conserved, and arthrodesis of the right sacroiliac joint was performed (Figure 5(b)).