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HPI - Symptoms started 2.5 years ago. History as below:
1) 01/2015: Pain at Right Ankle. No history of trauma. MRI: Bone marrow edema of Right Calcaneus. Non-weight bearing improved the clinical symptoms.
2) 10/2015: Pain at Right Hip. No history of Trauma. MRI: Bone marrow edema of Right Hip (Femoral head and small bone marrow edema of acetabulum). Non-weight bearing improved the symptoms.
3) 06/2016: Pain at Left Ankle. No history of trauma. MRI (Both ankles): Bone marrow edema of Left Calcaneus. No Bone marrow edema in Right Ankle.
4) 09/2016: Pain at Right Ankle. No history of trauma. MRI (on both ankles, images attached).
MRI(Right Ankle): Bone marrow edema of Cuboid, Base of 2nd metatarsal and medial cuneiform bone.
MRI(Left Ankle): Bone marrow edema of Cuboid, Middle & Medial cuneiform bones, base of 2nd and 4th metatarsal bone. Osteochondral dissecans of talar dome.
Non-weight bearing improved the symptoms.
5) 12/2017: Pain at Right ankle. No history of trauma. MRI of Right Ankle (images attached): Bone marrow edema of distal/metaphysis & epiphysis of right tibia.
CBC, Glucose, Urea, Creatinine, HDL, LDL, SGOT, SGPT, ALP, Fe, Ca, P, LDH, K, Na, PT, aPTT, d-dimers, TSH, FT4, CRP, ESR, Ra-Test, C3, C4, Anti-CCP, ANA, ACA-G/M, β2 GPI IgG/IgM: ALL NORMAL VALUES
What's your opinion? What's next in lab test/imaging/differential diagnosis?
HPI - 16F presents in January of 2015 with Left Ankle pain. No history of trauma/injury. Xrays are normal. MRI showed Bone Marrow Edema (BME). Non-weight bearing is advised.
In October of 2015, she presents with right hip pain/limited movement of her right hip because of pain. No history of trauma/injury. MRI’s (Right hip & Left ankle) show BME in her right hip and improved BME in her left ankle. Non-weight bearing and rest in advised.
In January of 2016 screening MRI’s (Right hip & Left ankle) are performed. They show an improvement of her previous BME in her right hip and eradication of the BME in her left ankle. Clinically, she is getting better.
In May of 2016 she presents with Right ankle pain with limited movement due to the pain. No history of trauma/injury. MRI is performed and it again shows BME of her Right ankle and Right calcaneus.
Lab tests (lupus, ACA, β2 GPI, thyroid hormones, protein electrophoresis, CRP, RA-test, C3, C4, Anti-CCP, ANA, FBC,ESR, PT/APTT, INR, D-dimers) are all normal.
Her symptoms were getting better until today. We have already planned MRIs of both her ankles and Right hip.
Xrays & MRI pics are attached.
What is the likely diagnosis in this patient?