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      Signo radiológico: "Nariz del oso hormiguero" Translated title: Radiological sign: "The Anteater Nose"

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          Abstract

          La coalición tarsal corresponde a la unión anormal, ya sea ósea, cartilaginosa o fibrosa, entre dos o más huesos del retro o medio pie. El signo de la nariz del oso hormiguero es causada por un alargamiento tubular del proceso anterior del calcáneo que se acerca o se superpone con el escafoides tarsiano y se asemeja a la nariz de un oso hormiguero en una radiografía lateral del pie o tobillo.

          Translated abstract

          The tarsal coalition corresponds to the abnormal osseous, cartilaginous or fibrous joining between two or more bones in the midfoot or hindfoot. The anteater nose sign is caused by a tubular elongation of the anterior process of the calcaneus that approaches or overlaps the tarsal scaphoid (navicular) and resembles the nose of an anteater on a lateral foot or ankle radiograph.

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          Congenital tarsal coalition: multimodality evaluation with emphasis on CT and MR imaging.

          Congenital tarsal coalition is a diagnosis that is often overlooked in young patients who first present with foot and ankle pain. Calcaneonavicular and talocalcaneal coalitions are encountered most frequently; fusion at other sites is much less common. Tarsal coalitions may be osseous, cartilaginous, or fibrous. Calcaneonavicular coalitions are readily detected on oblique radiographs. Radiographic confirmation of talocalcaneal coalition is more difficult than for fusion at other locations, although several secondary radiographic signs may indirectly suggest the diagnosis. Computed tomography (CT) and magnetic resonance (MR) imaging are invaluable for assessment of tarsal coalitions because they allow differentiation of osseous from nonosseous coalitions and because they depict the extent of joint involvement as well as secondary degenerative changes, features of vital importance in surgical planning. Short-inversion-time inversion recovery MR images may reveal bone marrow edema along the margins of the abnormal articulation, an important clue to the diagnosis. Moreover, CT or MR imaging may be required to confirm the diagnosis of talocalcaneal coalition when radiographic findings are equivocal. Because the diagnosis of tarsal coalition is often not entertained by the clinician ordering a CT or MR imaging examination, multiplanar imaging of the ankle and hindfoot is required.
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            Radiographic diagnosis of tarsal coalition.

            The objective of this study was to evaluate the sensitivity of unenhanced radiographic diagnosis of tarsal coalition. The study had two phases. The first was a retrospective case and control review. Radiographs of 37 feet (15 talocalcaneal coalitions and 15 calcaneonavicular coalitions) and of 17 patients with foot pain and no coalition used as controls were reviewed independently by three observers who had no prior knowledge of the cases. Each observer reviewed the cases for individual signs of coalition and then decided if coalition was present. The second phase of the study was a prospective evaluation by a single observer of 150 consecutive weightbearing foot radiographs obtained to evaluate nontraumatic foot pain. Patients diagnosed as positive for coalition underwent CT. On retrospective review of unenhanced radiographs, observers achieved 100% sensitivity and 88% specificity in the diagnosis of talocalcaneal coalitions. Sensitivity and specificity for calcaneonavicular coalitions ranged from 80% to 100% and 97% to 98%, respectively. Several previously unpublished radiographic signs increased sensitivity of diagnosis. For calcaneonavicular coalition, the new signs were altered navicular morphology and visualization of the bar on the anteroposterior radiograph. For talocalcaneal coalition, the new signs were a dysmorphic sustentaculum tali, nonvisualization of the middle subtalar facet, and shortening of the talar neck. In the prospective phase of the study, three talocalcaneal coalitions were detected with no false-positive results. Routine anteroposterior and lateral unenhanced radiographs are a valuable screening tool for tarsal coalition, even when used by inexperienced observers. The newly described signs increase sensitivity of radiographic diagnosis.
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              Analysis of calcaneonavicular coalitions using multi-planar three-dimensional computed tomography.

              Computed tomography (CT) is the current imaging standard for confirming the diagnosis of a calcaneonavicular coalition. The purpose of this study was to evaluate three-dimensional (3D) multi-planar CT images of calcaneonavicular coalitions and adjacent tarsal relationships, compared to controls, in order to obtain an understanding of the 3D anatomy for classification and as an aid to surgical resection.
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                Author and article information

                Journal
                rchradiol
                Revista chilena de radiología
                Rev. chil. radiol.
                Sociedad Chilena de Radiología (Santiago, , Chile )
                0717-9308
                2014
                : 20
                : 4
                : 156-158
                Affiliations
                [02] Santiago orgnameClínica Las Condes orgdiv1Departamento de Diagnóstico por Imágenes Chile
                [01] Santiago orgnameUniversidad de Chile orgdiv1Clínica Las Condes Chile
                Article
                S0717-93082014000400006 S0717-9308(14)02000400006
                10.4067/S0717-93082014000400006
                21cc9382-d560-41bf-9c34-daac6dadf53e

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 19 March 2014
                : 17 August 2014
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 9, Pages: 3
                Product

                SciELO Chile

                Categories
                SIGNOS RADIOLOGICOS

                Anteater nose,Tarsal coalition,Nariz de oso hormiguero,Calcaneus - scaphoid,Coalición tarsal,Calcáneo-escafoidea

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