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Wednesday, September 26, 2018

Sesamoid Injury: MRI report.

Hey Dr. Blake, 

I found an article you had written where the Drs said a girl had broken her sesamoid bone but it ended up being a cyst. I am still waiting to hear from my dr and I am no radiologist, but based on my MRI results, I think  I may have the same thing.  I am so glad I found your article.  Here are my MRI results, any insight?  This is my 2nd opinion.  The first dr taped me up and told me to go run and let him know how it felt, I quickly sought a 2nd opinion.  Both of my Drs did think I broke my bone though.

History: Sesamoid bone.  Abnormal ultrasound.  Cyst.

Technique: Right forefoot MRI with and without contrast.

Sequences: Axial T2 proton density fat sat, coronal STIR, sagittal T1, coronal T1, sagittal T2 proton density fat-sat and coronal T1 fat sat sequences were obtained.  The patient was intravenously injected with 6 ccs of Gadavist contrast and post contrast multiplanar T1 fat sat sequences were obtained and submitted for review.

Comparisons: None.


The bone marrow signal: Heterogeneous T1 dark signal with a near serpentine appearance of the fibular sesamoid bone.  There is a corresponding increased T2 signal.  There is an enhancement with contrast.  There are no diastases.  There is an adjacent T2 bright signal with enhancement of the surrounding soft tissues.

There is a small first MTP joint effusion.

The plantar plates are unremarkable.

Tendons are unremarkable.

Impression: Nonspecific enhancing T2 bright fibular sesamoid bone signal with surrounding soft tissue enhancing T2 bright signal.  Question changes of sesamoiditis, AVN, or an intraosseous mass.

Dr. Blake's comment: The MRI report clearly shows the fibular sesamoid is hot and trying to heal. There is no indication of anything else. There is no definite diagnosis of sesamoid fracture, only that the bone is swollen for some reason. It could be a stress fracture, and you have to treat the worse case scenario with these. I would be happy to review the MRI scan if you want to mail to Dr. Rich Blake, 900 Hyde Street, San Francisco, Ca 94109. Rich

1 comment:

  1. Dr. Blake, thank you so much for responding. I had my follow up with my Dr. today and my fibular sesamoid is indeed fractured almost in 2 parts. My Dr. did have to talk with the radiologist about the MRI. Based on my activity level and wanting to go back to running along with chasing my three children around, my Dr. and I have decided on a sesamoid removal. I have been in a boot for over 3 weeks with no relief. We did try a steroid shot today as well to see if that would help until my surgery date. I will try to get my hands on a cd and send to you as well. I would love to keep you updated on my story. I take my three kids to Disney in 8 weeks so I’m working diligently to try to get better. My surgery is scheduled for October 8th.


Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.