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I love this case, because I

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think this is very educational.

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People often call this pathology when it

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isn't, and it is a great way of showing

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or illustrating how you can have bridging

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between the metaphysis and the epiphysis,

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and it can look bad because there's lots of

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brightness, but it actually is a normal finding.

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So let's look at this.

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This is a 14-year-old girl who came

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in with vague knee discomfort or pain.

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And we're looking at, uh, on the left, a

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sagittal fluid-sensitive fat-suppressed sequence

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and on the right, we're looking at a coronal

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fluid-sensitive fat-suppressed sequence. So

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I want to direct your attention. Right, so

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you notice as we go down we look for that

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trilaminar appearance and this is slightly

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older. So we're losing some of that tri

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laminar appearance and I'll show you some

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other sequences that demonstrate that better.

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But we can still appreciate some degree of

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brightness, at least, and some degree of darkness.

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Maybe you don't see the zone of vibrational

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calcification as well, separating those, those

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areas, but remember we said as you grow older,

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the conspicuity of that zone or trilaminar

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appearance gets less and less, but that's okay.

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What we do notice is right here, and this is

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at the lateral aspect of the femoral condyle.

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You can notice that on the right side

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as we see the line here, it really

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is the lateral side and sort of central,

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little, little, little off midline.

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There's an area of increased STIR signal,

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edema, if you will, of brightness that

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extends from this focal area of the physis

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and grows up in a brush-like manner, like

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somebody took a paintbrush and just swept

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up and a little bit and swept down, okay?

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And this is very characteristic of a

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condition called FOPE, F O P E, which

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stands for Focal Periphysial Edema.

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Now, in the past, people

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have called this pathology.

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It's not.

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This is how the physis begins to close.

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When there's closure, like I said

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before, it doesn't happen all at once.

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It happens at focal areas.

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And this is one area, typically central,

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typically in a teenager, uh, happens more

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often in boys, uh, girls than in boys,

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sorry, uh, but it can happen in both sexes.

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And this is what it looks like.

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As you have focal areas of concern.

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Metaphysis meeting epiphysis, there's still

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a little bit of micro movements that occur.

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And since it's anchored at this location,

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if you will, it's going to be a little

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bit of edema, a little bit of tension that

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goes in the metaphysis and the epiphysis.

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The key is not to call this abnormal, because

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this will eventually go away on its own.

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Other areas are formed, they'll grow away,

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and the physis will eventually close.

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To give you a more convincing image, let

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me go over here and bring this one up.

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This is again our gradient

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sequence, and look at this.

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You can actually see that trabecular bone

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extending all the way across our physis.

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Normal physis here, bright area, that's

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the cartilaginous portion, here, bridge,

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and here we have cartilage again.

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And as we look back and we look, you

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know, that's okay, little tongue of

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tissue of cartilage, that's not a problem.

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And you can see over here that it's

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about to form another area of bridge.

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It happens very, very gradually.

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And over here, that looks,

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uh, looks like another tissue.

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In fact, right over here, you can see it.

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So, it hasn't formed enough of a

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bridge to cause edema on either side.

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But it's okay.

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This, in the adolescent, is okay.

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And typically, we see it around the knee.

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So, don't call this a pathology.

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This is focal periphyseal edema, or FOPE.