Infected Re-Rupture
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Dr. P here.
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3 00:00:01,560 --> 00:00:04,390 This is a 47-year-old woman who's had an achilles
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repair, so-called a burrito wrap repair, which is
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novel for me and certainly doesn't make me hungry.
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On the left side, the T1-weighted image in the
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middle, the proton density fat suppression,
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and on the right, a gradient echo thin
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section image, which is going to show things
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like iron and calcium and hemosiderin, and susceptibility phenomenon.
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When you see an achilles that's separated
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like this and you have a huge ulcer to the
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outside world, a superficial ulcer like that,
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you must assume that you're dealing
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with an infected process and you can follow
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the exterior right into the tendon.
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And you really obliterate the tendon.
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I'm having a very hard time identifying
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it on T1, you say, okay, it's T1.
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Maybe it's tendinopathy.
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But when you get up into the water-weighted
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images, look at this tissue that is just
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simply wiping out the achilles and know
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that is not the sequela of the tear.
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That is infected material
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dissecting into the achilles itself.
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This is the remains of the burrito wrap,
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which probably came from maybe fascia
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latae or some other type of tissue.
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It too is infected, which creates
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a whole other set of problems.
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And then let's look at the axial projection.
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We've got a heavily water-weighted image on
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the left, a T1-weighted image in the middle.
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And a not-so-valuable T1 contrast
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enhanced image on the right.
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Not showing an abscess, but showing that
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there is some generalized enhancement here.
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And perhaps there's a little bit of
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fluid, laminar fluid right there.
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There's the ulceration,
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but I mean, where is the tendon?
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Here is the tendon, and look at all
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of this tissue that's infiltrating it
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diffusely as we move up into the calf.
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This is all infection in the achilles.
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So how to deal with this is above my pay grade,
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but certainly, resection of infected tissue
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and grafting from material that exists in other
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parts of the body has got to be a consideration.
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This is a post-operative
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infection of an achilles repair.
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Dr. P out.
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
ProScan Imaging
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