Os trigonum is a congenital condition in which a bone ossicle fails to fuse to a secondary ossification center in the posterior aspect of the talar bone. Repetitive plantar flexion of the foot may elicit inflammation of the ossicles fibrous connective band, subsequently causing pain. It is common to misdiagnose os trigonum as an avulsion fracture. We report a case of a 23-year-old male with symptomatic os trigonum diagnosed on Tc-99m hydroxymethylene diphosphonate single-photon emission computed tomography-computed tomography (SPECT-CT). We also wish to emphasize on the use of SPECT/CT in not only allocating the ossicle anatomically but also for the purpose of evaluation an active source of pain in a region of multiple complex small bones.
Subsolid pulmonary nodules (SSNs) are frequent findings on CT scans, and their reported prevalence ranges between 9 and 20% in the literature. The management of SSNs requires specific knowledge. In this review, we report the standard imaging approach and the potential role of positron emission tomography/computed tomography (PET/CT) in the detection of pulmonary SSNs, to help clinicians by providing evidence-based recommendations. The classification of the basic histology, nomenclature, and behaviours of the different lesions is described, with the typical imaging patterns and main recommendations for their management when detected on CT imaging. A comprehensive review of the literature has been performed to determine the potential role of 18F-fluorodeoxyglucose (18F-FDG) PET/CT in the evaluation of SSNs. Finally, we describe the synergy of CT and 18F-FDG PET in the evaluation and management of SSNs. We hypothesise that in cases of 18F-FDG-positive findings, it would be worth considering pre-emptive local treatment with ablation, radiotherapy, or surgical resection. New prospective studies with greater homogeneity of data acquisition, including imaging time points, would be beneficial when reappraising the role of 18F-FDG PET/CT following new technical developments.
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