Chronic Left Ankle Pain With An Unsuspected Cause: A Case Report

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Chronic Left Ankle Pain With An Unsuspected Cause: A Case Report - Page #3

Lab Studies: None Other Studies: MSK ultrasound in clinic showed the posterior tibial tendon with a large quantity of hypoechoic material within the tendon sheath. There was minimal hyperemia on doppler. <br> <br>An X-Ray of the L ankle <a href="CaseStudyImages/CS1ChronicLeftAnkleP-1103.jpg" title="Case Photo #1" data-lity><b>Case Photo #1</b></a> was unremarkable, without any osseous lesions. <br> <br>MRI of the L ankle without contrast <a href="CaseStudyImages/CS2CS1ChronicLeftAnk-1103.jpg" title="Case Photo #2" data-lity><b>Case Photo #2</b></a> <a href="CaseStudyImages/CS3CS2CS1ChronicLeft-1103.jpg" title="Case Photo #3" data-lity><b>Case Photo #3</b></a> <a href="CaseStudyImages/CS4CS3CS2CS1ChronicL-1103.jpg" title="Case Photo #4" data-lity><b>Case Photo #4</b></a> <a href="CaseStudyImages/CS5CS4CS3CS2CS1Chron-1103.jpg" title="Case Photo #5" data-lity><b>Case Photo #5</b></a> showed a mass-like fatty infiltration of the Posterior Tibial tendon with extension to the flexor digitorum longus and to the navicular insertion of the Posterior Tibial tendon. Per the report, this represented a possible intramuscular lipoma vs low grade liposarcoma or lipoma arborescens of the tendon sheath. An MRI with contrast was recommended to further assess. <br> <br>MRI of the L ankle with contrast <a href="CaseStudyImages/CS6CS5CS4CS3CS2CS1Ch-1103.jpg" title="Case Photo #6" data-lity><b>Case Photo #6</b></a> <a href="CaseStudyImages/CS7CS6CS5CS4CS3CS2CS-1103.jpg" title="Case Photo #7" data-lity><b>Case Photo #7</b></a> <a href="CaseStudyImages/CS8CS7CS6CS5CS4CS3CS-1103.jpg" title="Case Photo #8" data-lity><b>Case Photo #8</b></a> <a href="CaseStudyImages/CS9CS8CS7CS6CS5CS4CS-1103.jpg" title="Case Photo #9" data-lity><b>Case Photo #9</b></a> was read as a synovial tendon lipomatosis (lipoma arborescens) of the Posterior Tibial tendon and Flexor Digitorum Longus. This is a nonspecific reactive synovial fatty proliferation. <br> <br>A biopsy was performed which resulted in final pathology significant for a tenosynovial giant cell tumor, diffuse type. Consultations: Foot and Ankle Orthopedic Surgery Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.		Back
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