Medical Imaging Analysis Report

1. Imaging Findings

Based on the CT and MRI images, the bony structures near the distal tibia and talus of the child’s left ankle show the following characteristics:

• In the epiphyseal region of the ankle joint, local bone overgrowth-like changes are visible, and the bony contour appears irregular.
• On CT, multiple irregular cartilage-like densities are observed, with several small patchy ossification foci, accompanied by marginal bony remodeling and mild deformation.
• MRI demonstrates excessive cartilage proliferation in the medial epiphysis of the ankle joint. Cartilage-like signals appear as high signals on T2-weighted images, with localized sclerosis or signal changes in the bone.
• No extensive soft tissue swelling is observed. The joint space is relatively preserved, with localized cartilage hypertrophy.

Overall, these findings indicate unilateral epiphyseal proliferation consistent with the imaging features of “Dysplasia epiphysealis hemimelica (DEH), also known as Trevor disease.”

2. Possible Diagnoses

Combining the imaging findings with the child’s clinical history (8-year-old, chronic ankle pain gradually worsening, no history of trauma, infection, tumor, or surgery), the following potential diagnoses are considered:

1. Dysplasia epiphysealis hemimelica (Half-side epiphyseal dysplasia): Common in childhood, typically involves a single-sided epiphyseal region with asymmetric distribution, accompanied by cartilage proliferation and possibly multiple small ossification centers.
2. Osteochondroma: Before epiphyseal closure, a prominent cartilage cap may be noted, but it generally originates from the metaphysis, often presenting as an exostosis, which differs from the predominantly epiphyseal changes in this case.
3. Chondromyxoid fibroma or other cartilaginous tumors: Imaging usually reveals cartilaginous calcifications, often more localized. In this case, lesions are single-sided, multifocal, and diffuse with no obvious invasive presentation, suggesting a benign process.

Given the child’s age, location of the lesion, and the typical “excessive epiphyseal cartilage proliferation,” “Dysplasia epiphysealis hemimelica” is the primary consideration.

3. Final Diagnosis

Based on the child’s medical history, imaging characteristics, and the typical unilateral overgrowth changes of the ankle epiphysis, the most likely diagnosis is:

Dysplasia epiphysealis hemimelica (Trevor disease).

If uncertainty remains, further confirmation can be sought through pathological examination and follow-up imaging to rule out rare chondroid tumors or other skeletal developmental abnormalities.

4. Treatment Plan and Rehabilitation

4.1 Treatment Strategy

• Conservative management: For children with mild symptoms or no significant functional impairment, regular follow-up observation can be performed, along with physical therapy and symptomatic pain control. If the lesion does not progress and function remains adequate, long-term observation may be sufficient.
• Surgical treatment: If the lesion causes significant pain, limited range of motion, or progressive deformity, surgical intervention such as lesion excision or corrective surgery may be considered. However, in children with open growth plates, there remains a risk of recurrence after surgery.

4.2 Rehabilitation/Exercise Prescription Recommendations

• General Principles of Rehabilitation: Follow the FITT-VP framework (Frequency, Intensity, Time, Type, Progression, and Individualization):
  • Frequency: Perform basic joint range of motion training 2-3 times a week, adjusting according to pain and fatigue levels.
  • Intensity: Begin with low-intensity joint mobility and muscle strength exercises, gradually increasing difficulty.
  • Time: Each exercise session should last about 20-30 minutes, with gradual increases based on tolerance.
  • Type: Focus on non-weight-bearing or partial weight-bearing exercises (e.g., seated ankle joint active movements, isometric lower limb muscle training), supplemented by low-impact aerobic activities (e.g., swimming or recumbent cycling).
  • Progression: Once the child’s pain has significantly improved and joint range of motion increases, gradually incorporate mild targeted strength training, such as ankle resistance exercises and core muscle strengthening.
  • Individualization: Adjust exercise content and goals according to the child’s skeletal development and pain levels.
• Specific Training Examples:
  • Ankle Joint Range of Motion (ROM) Exercises: Ankle dorsiflexion, plantarflexion, and circumduction, holding each direction for 3-5 seconds, 1-2 sets per day, 10 repetitions per set.
  • Resistance Exercises: Use elastic bands or manual resistance for light resistance during ankle dorsiflexion or plantarflexion, 2 times a week, gradually increasing the resistance of the band.
  • Non-Weight-Bearing Aerobic Exercise: Swimming or seated cycling for 15-20 minutes, 2-3 times a week, avoiding excessive impact on the ankle joint.
• Precautions:
  • If the child experiences significant pain or swelling during training, stop immediately and consult a physician or rehabilitation therapist.
  • If the condition progresses or deformity appears, promptly evaluate the indication for surgery.