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. An X-Ray of the L ankle Case Photo #1 was unremarkable, without any osseous lesions. MRI of the L ankle without contrast Case Photo #2 Case Photo #3 Case Photo #4 Case Photo #5 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. MRI of the L ankle with contrast Case Photo #6 Case Photo #7 Case Photo #8 Case Photo #9 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. 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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