Tumours of the talus - A pictorial review

Abstract

Background: Primary bone tumours of the talus are a rare entity and seldom described in the literature. Due to this, often the diagnosis and management of such cases are delayed. This study aims to describe a spectrum of lesions identified within our department and provide a pictorial review with the goal to aid radiologists in the evaluation and diagnosis of such lesions.

Materials & methods: A retrospective study was conducted within our department, identifying all talar lesions, confirmed on histopathological and radiological diagnosis.

Results: Results revealed 75 cases of talar lesions. Benign tumours formed the bulk of the lesions identified accounting for 85% of all cases. The most common benign tumour was chondroblastoma (n = 23). Malignant tumours were detected in 6 cases. Other lesions included osteomyelitis and avascular necrosis.

Conclusion: We present a variety of tumours and tumour-like conditions of the talus. Radiologists as well as orthopaedic surgeons need to be aware of such lesions, to prompt early diagnosis and initiate management in timely fashion.

Keywords: Lesion; Talus; Tumours.

Fig. 1

The anatomy of the talus.

Fig. 2

Histology results in our patient cohort in percentage.

Fig. 3

Proposed diagnostic algorithm for assessment of talar lesions.

Fig. 4

Chondroblastoma. Radiographs (AP-a, lateral –b) of chondroblastoma with the talus demonstrating a well-defined lytic lesion in the body of the talus with a thin sclerotic margin (arrows).

Fig. 5

Chondroblastoma. Axial T1(a), STIR axial (b and c) demonstrating an intermediate signal intensity lesion (a) and high signal on STIR (b) with lobulated internal architecture and lobulated margins and fluid-fluid levels (c).

Fig. 6

Osteoid osteoma. Radiographs, AP (a) and lateral (b) of an osteoid osteoma in the dorsal neck of the talus demonstrating a faint lucent lesion with surrounding sclerosis (arrows).

Fig. 7

Osteoid osteoma. Axial CT(a) of an osteoid osteoma (arrow) in the dorsal neck of the talus demonstrating a low attenuation nidus with central calcification and surrounding sclerosis. Axial T1 (b) and sagittal STIR(c) of an osteoid osteoma (arrow) in the dorsal neck of the talus demonstrating minor osseous oedema and a small effusion of the talo-crural joint.

Fig. 8

Osteoblastoma. Radiographs (AP-a and lateral –b) of an osteoblastoma in the dorsal talus at the junction of the body and neck demonstrating a subtle rounded sclerotic focus (arrows).

Fig. 9

Osteoblastoma. Sagittal T1 (a) and STIR (b) showing an osteoblastoma (arrow) in the dorsal aspect of the talar neck with osseous oedema and small joint effusion. Axial CT (c) of an osteoblastoma in the dorsal talus demonstrating a lytic lesion with osteoid matrix mineralisation.

Fig. 10

Aneurysmal bone cyst. Radiograph (AP-a) of an ABC in the talus demonstrating an expansile lucent lesion in the medial aspect of the body of the talus (arrow). Sagittal T1 (b) and axial STIR (b) showing fluid-fluid levels within the lesion (arrow) in the talar body and neck.

Fig. 11

Giant cell tumour. Sagittal CT (a) demonstrating a lytic lesion in the neck of talus involving the subarticular bone. Sagittal T1 (b) and axial STIR (c) showing lesion in the talar neck (arrow).

Fig. 12

Osteosarcoma of talus. Radiograph (lateral –a), STIR sagittal (b), axial T1 (c) demonstrating a lucent lesion in the neck of the talus on radiographs and intermediate signal on T1 and high on STIR (arrow) with increased uptake on bone scan (d).

Fig. 13

Metastasis in talus from endometrial carcinoma. Lateral radiograph (a) of ankle showing large destructive lesion in talus. Axial T1 (b) and STIR sagittal (c) demonstrates lesion involving the entire talus (arrow).