{
 "serie": "s701_DP_SPAIR_COR",
 "n_imgs": 24,
 "s": 67.4,
 "respuesta": "**Series:** Coronal PD SPAIR, right ankle (anterior → posterior; image left = lateral/fibula, image right = medial). Fat suppression is inhomogeneous peripherally (medial/plantar heel soft tissues appear artefactually bright), which limits assessment of the plantar/medial soft tissues. Only fluid-sensitive images are available, so cartilage/osteophyte assessment is limited.\n\n**Joint fluid / synovium**\n- Tibiotalar joint effusion, small-to-moderate: fluid outlining the plafond/talar dome (slices 8–10), extending into the anterior recess along the talar neck (slices 5–7) and into the posterior recess (slices 12–14). Slightly irregular/thickened intermediate signal in the anterior recess, favouring synovitis/scar in this post-arthroscopy ankle. Confidence: high (effusion), medium (synovitis).\n- Medial gutter fluid/synovitis between medial malleolus and medial talus (slices 6–8, 11), with poorly defined superficial deltoid fibres – suggests chronic deltoid/medial gutter scarring. Confidence: medium.\n- Lateral gutter fluid between distal fibula and lateral talus (slices 8–9), region of ATFL – ATFL not clearly identified as a well-defined band; findings compatible with chronic ATFL insufficiency/scarring after remote sprain. Confidence: medium (a true axial series is needed for confirmation).\n- Posterior subtalar joint fluid (slices 9–11), mild. Confidence: medium.\n\n**Bones**\n- No definite bone marrow oedema in the talar dome, tibial plafond, fibula or calcaneus on the sampled slices. A subtle ill-defined focal high signal at the posterior/posteromedial tibial plafond–talus interface (slices 12–13) is more likely posterior recess fluid than subchondral oedema. Confidence: low for any osseous lesion.\n- No fracture, no osteochondral lesion confidently identified (talar dome subchondral bone appears intact on slices 8–10). Small irregularity of the anterior tibial/talar margin (slices 6–8) may reflect post-arthroscopic (osteophyte-resection) change. Confidence: low.\n- Small high-signal focus at the tip of the lateral malleolus (slices 10–11): fluid in the peroneal tendon sheath or lateral gutter rather than marrow oedema. Confidence: low.\n\n**Sinus tarsi**\n- Increased signal in the sinus tarsi/tarsal canal between the lateral talus and calcaneus (slices 7–8), with poorly defined interosseous/cervical ligament fat – suggests sinus tarsi fluid/scarring (sinus tarsi syndrome pattern, consistent with prior inversion injury). Confidence: medium.\n\n**Tendons**\n- Small amount of fluid around the posteromedial flexor tendons (FHL/FDL region) posterior to the talus (slices 12–14); likely communicating with the tibiotalar joint via the FHL sheath and of doubtful significance. Tendons otherwise appear intact in calibre. Confidence: medium.\n- Achilles tendon: appears low signal and of normal thickness on the posterior slices (15–18); no retrocalcaneal bursal fluid definitively seen. Confidence: medium (limited by plane).\n- Peroneal tendons: no clear tear; trace peritendinous fluid at lateral malleolar tip possible (see above). Confidence: low.\n\n**Soft tissues**\n- Curvilinear high signal within the heel fat pad and medial plantar soft tissues (slices 13–18) most likely represents the medial plantar venous plexus and incomplete peripheral fat suppression rather than true oedema; no discrete mass or abscess. Confidence: medium.\n- No significant subcutaneous oedema of the leg. Musculature of the distal leg shows normal signal.\n\n**Impression**\n1. Tibiotalar joint effusion with anterior recess synovitis/scar, in keeping with post-traumatic/post-arthroscopic change.\n2. Medial and lateral gutter fluid/synovitis with indistinct ATFL and superficial deltoid – chronic ligamentous injury/scarring likely (correlate with axial images).\n3. Sinus tarsi fluid/scarring.\n4. Mild posterior subtalar effusion and minor flexor tendon sheath fluid.\n5. No bone marrow oedema, fracture or osteochondral lesion confidently identified on this fluid-sensitive series; correlate with T1/PD non-fat-sat and sagittal/axial sequences."
}