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from Section 7 - Musculoskeletal
Published online by Cambridge University Press: 05 March 2013
Imaging description
A radiograph obtained for acute trauma or musculoskeletal extremity pain reveals an extraosseous structure. Close inspection reveals that the bone is round and well corticated on all sides, as opposed to the appearance expected for an acutely avulsed fragment of bone. Perhaps correlation with physical exam reveals no focal tenderness at the site of the accessory ossicle, effectively excluding acute fracture. Alternatively, if the physical exam is unreliable or if clinical suspicion persists, a CT might show the complete cortication and lack of osseous donor site. An MRI may be obtained if there is concern that the accessory ossicle is itself the source of ongoing subacute or chronic pain, in which case bone marrow edema would be revealed on both sides of the synchrondrosis between the accessory ossicle and parent bone.
Importance
The number of described accessory ossicles is very large. Their clinical significance lies in the fact that they can simulate acute avulsions radiographically and they can be symptomatic themselves.
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