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Ectopic pregnancy within 1st MTP

Discussion in 'General Issues and Discussion Forum' started by Mart, Sep 6, 2013.

  1. Mart

    Mart Well-Known Member


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    Hi All

    interesting case a couple of days ago

    healthy 30 yo female

    insidious onset 1st MTP pain, denied recollection of a traumatic event or prior foot surgery. No pattern to pain but tends to be worsened with increased activity, improved with rest

    no prior workup

    VAS (visual analogue pain scale range 0-10) VAS (visual analogue pain scale range 0-10) 1 to VAS 10: worst pain possible and necessitates occasional bedrest

    noting feeling of "something kicking within affected joint"

    no relevant co-morbidity

    reported being unable to exercise because of foot pain (usually runs 30 minutes 4x per week

    P/E

    no signs of swelling, erythema, heat or skin lesions other than slight dorsal MTP prominence

    pain with passive dorsiflexion of 1st MTP and to palpation of dorsal joint line.

    US showing joint effusion with inhomogeneous hyperechoic debris and here's the kicker . . . . on closer examination . ..... a fully formed fetus within synovial envelope

    image below


    US image 1.jpg

    This is as far as I know unreported before in the medical literature

    the little rascal is clearly a male with a bit of a boner going on.

    I am submitting case report to which I think may be of interest - check out URL below

    http://www.cbc.ca/thisisthat/index.html

    Cheers

    Martin
     
  2. wdd

    wdd Well-Known Member

    So. The ovum was fertilised in the normal way and in the normal place but didn't implant in the womb?

    After that it must have fallen out of the vagina and onto the foot before making its way down to the toe. Lucky it didn't get kicked off on the way down the foot. Then it burrowed into the soft tissue of the great toe and then blasted its way through the bone and at least for some time continued to develop. After an adventure like that how can anyone deny the existence of miracles?

    Could it be a fetus in fetu or even a teratoma?

    Bill
     
  3. Mart

    Mart Well-Known Member

    Hi Bill

    teratoma is an interesting call .. . . however the boner seems well differentiated and somewhat active with P/E.

    Another possibility which I didn't mention is that patient did mention a "being kidnapped by aliens" experience around onset of symptoms. I had dismissed this this as likely FMS - False memory syndrome (lot of it about in Manitoba) but perhaps a terrortoeatoma or extraterratoraloma might also be reasonable DDx.

    I think on balance this shows the powerful utility of sonography in the wrong hands and capacity for bad puns in the wrong minds

    Cheers

    Martin


    Foot and Ankle Clinic
    1365 Grant Ave.
    Winnipeg Manitoba R3M 1Z8
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
  4. wdd

    wdd Well-Known Member

    Wow Martin. If that's an alien pregnancy, what is alien sex like? I would think that boner has to be translated literally? 'How was it for you', is likely to have a completely different meaning as is the big OOHHH or even the big TOOOE!

    I'm amazed that Toeslayer isn't on to this one as it takes footfetish to another level!

    Bill
     
  5. Sounds like a case for Brian Rothbart...right down his alley...:rolleyes:
     
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