Figure 1: Plain x-ray of the ankle showing multiple pathologies as annonated in Figure 2.

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Figure 2: Annotated plain x-ray image of the ankle of Figure 1 showing disused atrophy, arterial wall calcification and gas gangrene in soft tissue of the sole.

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Not everything in medicine necessarily requires an imaging investigation, in particular a plain x-ray.  However, sometimes they are undertaken for an alternative indication yet reveal findings one must understand and interpret, despite it perhaps being much more obvious clinically.


In addition, a single x-ray may reveal more than one pathology which are often related to the same underlying condition.


A classical example of this is a patient with long standing poorly controlled diabetes, with the multitude of complications which may be set this patient group.

For example,

  1. An ultrasound neck, may reveals a carotid artery stenosis (due to atherosclerosis) and an enlarged parathyroid gland ( from secondary hyperparathyroidism.
  2. A CT abdomen may demonstrate atrophic kidneys (diabetic microvascular disease) and the dense bony skeleton of renal osteodystrophy.
  3. A plain film of the foot revealing a Charcotís joint (a result of diabetic neuropathy ) along with the profound digital artery calcification (due to atherosclerosis).
  4. Or as in this case, a diffusely abnormal texture to the bones of the foot due to disuse (Sudekís ) atrophy along with multiple foci of gas in the soft tissue due to gangrene ( Figure 1 & 2).  This is a pre-amputation film in the extent of disease.




Images and text contributed by

Dr Ian Bickle, Department of Radiology,RIPAS Hospital

All images are copyrighted and property of RIPAS Hospital.