PLANTAR THROMBOPHLEBITIS: MAGNETIC RESONANCE IMAGING FINDINGS

Abstract

Objective: Demonstrate the magnetic resonance imaging (MRI) findings in plantar thrombophlebitis.

Methods: Retrospective review of twenty patients with pain in the plantar region of the foot, in which the MRI findings indicated plantar thrombophlebitis.

Results: A total of fourteen men and six women, mean age 46.7 years were evaluated. Eight of these patients also underwent Doppler ultrasonography, which confirmed the thrombophlebitis. The magnetic resonance images were evaluated in consensus by two radiologists with experience in musculoskeletal radiology (more than 10 years each), showing perivascular edema in all twenty patients (100%) and muscle edema in nineteen of the twenty patients (95%). All twenty patients had intraluminal intermediate signal intensity on T2-weighted (100%) and venous ectasia was present in seventeen of the twenty cases (85%). Collateral veins were visualized in one of the twenty patients (5%). All fourteen cases (100%), in which intravenous contrast was administered, showed perivenular tissues enhancement and intraluminal filling defect. Venous ectasia, loss of compressibility and no flow on Doppler ultrasound were also observed in all eight cases examined by the method.

Conclusion: MRI is a sensitive in the evaluation of plant thrombophlebitis in patients with plantar foot pain.

Keywords: Foot; Magnetic Resonance Imaging; Thrombophlebitis.

Figure 1

Female patient, 40 years. Coronal T2WI FSE with fat saturation (A) – Edema in the myoadipose planes, around the plantar metatarsal vein between metatarsals II and III of the right forefoot. Coronal T1WI FSE with fat saturation and contrast (B) – Venular distension with intraluminal filling defect and enhancement of perivascular tissue.

Figure 2

Male patient, 50 years. Sagittal T2WI FSE with fat saturation and sagittal T1WI FSE (A/B) – Intraluminal intermediate signal in T1WI and T2WI. Sagittal T1WI FSE with fat saturation and contrast (C) – Intraluminal filling defect within the lateral venous system of the hindfoot.

Figure 3

Male patient, 31 years. Coronal and axial T1W with fat saturation and contrast (A-B) – Collateral veins in the topography of the plantar metatarsal system, in a patient who was diagnosed with deep plantar thrombophlebitis, probably representing a chronic case.

Figure 4

Male patient, 49 years. Coronal T2WI FSE with fat saturation and T1WI FSE with fat saturation and contrast (A-B) – Perivascular enhancement after gadolinium injection, around the plantar metatarsal vein of the second ray of the right forefoot.

Figure 5

Female patient, 43 years. Coronal and axial T1WI FSE with fat saturation and contrast (A-B) – Intraluminal filling defect in the plantar digital vein of the second ray of the left forefoot.

Figure 6

Simplified diagram of the venous anatomy of the plantar region.

Figure 7

Male patient, 50 years old, with pain in the plantar region. (A-B) Plantar thrombophlebitis in the topography of the lateral plantar veins with perivascular edema and enhancement, muscle edema, venular ectasia, and intraluminal filling defect. (C) Ultrasound of the lateral plantar region of the foot with color doppler confirming the absence of flow in the lateral plantar vein.