MRI Online
Library

View this list on the Library Page

ResidentsGroupsPricing
MRI Online
MRI Online
MRI Online
Library

View this list on the Library Page

6b - Answer: 48-year-old male presents with pain in posterior right calcaneus

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY: 

This 48-year-old male presents with pain in the posterior right calcaneus.

(QUIZ ANSWER) NOT A FINDING IN THIS CASE: 

Retrocalcaneal bursitis.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS:

Swelling of the posterior medial and lateral retinacula. 

Suspect calcaneal osteotomy and Achilles has been reattached to the calcaneus. The repair is reportedly to have taken place almost 8 months ago. The pattern of reaction around the anchors, in the Achilles, and around the Achilles suggests an inflammatory yet sterile response. In other words, no bone destruction is identified. 

The Achilles is diffusely swollen while the tissues deep to it as well as the tissues in the Achilles immediately underneath it are edematous. Some of this edema is exaggerated by aspect ratio and geometric distortion. 

Incidental note is made of a large lateral posterior talar process with a small amount of surrounding fluid likely an incidental or coincident finding. 

Less than 5% of the deeper fibers of the Achilles are frayed at the top of the calcaneal margin. 

CONCLUSION

Active interstitial tendinopathy, peritendinitis, marrow edema, periostitis, and soft tissue swelling for which an inflammatory sterile reaction is favored over an infectious one. This is based on the pattern of inflammation and a lack of bone destruction. Achilles itself is hypertrophic 1-1/2 times in overall thickness. 

LESSON 2, TOPIC 18

Case Challenge: Foot & Ankle MRI Cases

Case Challenge

Browse other topics in...

Content reviewed: August 31, 2021

View CME activity information