0:00

Dr. P here.

0:01

3 00:00:01,560 --> 00:00:04,390 This is a 47-year-old woman who's had an achilles

0:04

repair, so-called a burrito wrap repair, which is

0:09

novel for me and certainly doesn't make me hungry.

0:13

On the left side, the T1-weighted image in the

0:15

middle, the proton density fat suppression,

0:17

and on the right, a gradient echo thin

0:20

section image, which is going to show things

0:23

like iron and calcium and hemosiderin, and susceptibility phenomenon.

0:28

When you see an achilles that's separated

0:31

like this and you have a huge ulcer to the

0:35

outside world, a superficial ulcer like that,

0:37

you must assume that you're dealing

0:40

with an infected process and you can follow

0:42

the exterior right into the tendon.

0:46

And you really obliterate the tendon.

0:48

I'm having a very hard time identifying

0:51

it on T1, you say, okay, it's T1.

0:54

Maybe it's tendinopathy.

0:55

But when you get up into the water-weighted

0:57

images, look at this tissue that is just

0:59

simply wiping out the achilles and know

1:04

that is not the sequela of the tear.

1:06

That is infected material

1:08

dissecting into the achilles itself.

1:11

This is the remains of the burrito wrap,

1:14

which probably came from maybe fascia

1:16

latae or some other type of tissue.

1:19

It too is infected, which creates

1:21

a whole other set of problems.

1:24

And then let's look at the axial projection.

1:26

We've got a heavily water-weighted image on

1:28

the left, a T1-weighted image in the middle.

1:31

And a not-so-valuable T1 contrast

1:34

enhanced image on the right.

1:36

Not showing an abscess, but showing that

1:39

there is some generalized enhancement here.

1:42

And perhaps there's a little bit of

1:44

fluid, laminar fluid right there.

1:46

There's the ulceration,

1:48

but I mean, where is the tendon?

1:50

Here is the tendon, and look at all

1:52

of this tissue that's infiltrating it

1:55

diffusely as we move up into the calf.

1:57

This is all infection in the achilles.

2:00

So how to deal with this is above my pay grade,

2:03

but certainly, resection of infected tissue

2:06

and grafting from material that exists in other

2:10

parts of the body has got to be a consideration.

2:13

This is a post-operative

2:15

infection of an achilles repair.

2:18

Dr. P out.

Infected Re-Rupture

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Pro Tip: Click on a word in the transcript to jump to that point in the video

0:00

Dr. P here.

0:01

3 00:00:01,560 --> 00:00:04,390 This is a 47-year-old woman who's had an achilles

0:04

repair, so-called a burrito wrap repair, which is

0:09

novel for me and certainly doesn't make me hungry.

0:13

On the left side, the T1-weighted image in the

0:15

middle, the proton density fat suppression,

0:17

and on the right, a gradient echo thin

0:20

section image, which is going to show things

0:23

like iron and calcium and hemosiderin, and susceptibility phenomenon.

0:28

When you see an achilles that's separated

0:31

like this and you have a huge ulcer to the

0:35

outside world, a superficial ulcer like that,

0:37

you must assume that you're dealing

0:40

with an infected process and you can follow

0:42

the exterior right into the tendon.

0:46

And you really obliterate the tendon.

0:48

I'm having a very hard time identifying

0:51

it on T1, you say, okay, it's T1.

0:54

Maybe it's tendinopathy.

0:55

But when you get up into the water-weighted

0:57

images, look at this tissue that is just

0:59

simply wiping out the achilles and know

1:04

that is not the sequela of the tear.

1:06

That is infected material

1:08

dissecting into the achilles itself.

1:11

This is the remains of the burrito wrap,

1:14

which probably came from maybe fascia

1:16

latae or some other type of tissue.

1:19

It too is infected, which creates

1:21

a whole other set of problems.

1:24

And then let's look at the axial projection.

1:26

We've got a heavily water-weighted image on

1:28

the left, a T1-weighted image in the middle.

1:31

And a not-so-valuable T1 contrast

1:34

enhanced image on the right.

1:36

Not showing an abscess, but showing that

1:39

there is some generalized enhancement here.

1:42

And perhaps there's a little bit of

1:44

fluid, laminar fluid right there.

1:46

There's the ulceration,

1:48

but I mean, where is the tendon?

1:50

Here is the tendon, and look at all

1:52

of this tissue that's infiltrating it

1:55

diffusely as we move up into the calf.

1:57

This is all infection in the achilles.

2:00

So how to deal with this is above my pay grade,

2:03

but certainly, resection of infected tissue

2:06

and grafting from material that exists in other

2:10

parts of the body has got to be a consideration.

2:13

This is a post-operative

2:15

infection of an achilles repair.

2:18

Dr. P out.

Report

Faculty

Stephen J Pomeranz, MD

Chief Medical Officer, ProScan Imaging. Founder, MRI Online

ProScan Imaging

Lesson

Foot & Ankle MRI Mastery Series: Pre-Course Activities

Lesson

Foot & Ankle MRI Mastery Series: Introduction

Lesson

Foot & Ankle MRI Mastery Series: Protocols and Sequences

Lesson

Foot & Ankle MRI Mastery Series: Anatomy

Lesson

Foot & Ankle MRI Mastery Series: Mid-foot Anatomy

Lesson

Foot & Ankle MRI Mastery Series: Case Review

Lesson

Foot & Ankle Masses

Infected Re-Rupture