I have learned that this patient is an insulin dependent diabetic, on antihypertensive medication and statins.No history of arthritis.
Thanks to the several people who commented:
Most of you favor inflammation of the peritenon..some mention the Tib Anterior tenosynovitis as possibly related.
Some mentioned the possibility of crystal deposition or RA nodule.
2 people wondered about an adventitial bursa from shoegear / activity, as you might see (usually at the medial ankle) in ice skaters. This seems an odd location for that to me.
While I share the opinion that this is likely inflammatory, I was concerned that it might be an unusual neoplasm.
To that point, I am told that the this appearance, slightly bright T1 signal and age can fit for myxofibrosarcoma.
I’ve seen a few reports of GCTTS in this location, though I couldn’t access the full articles on those reports.
Unfortunately it has proven impossible to contact the referrer who is a PA from a "doc-in-a-box" clinic in the suburbs….I don’t think she was seen by an actual doctor.
I’m hoping for a call back…but I won’t hold my breath.
Doesn’t bode well for path follow-up, but I will try.
I will give a broad differential, favoring inflammation but including the unlikely possibility of benign and aggressive soft tissue neoplasm, and recommend US and biopsy.
Thanks for your assistance.
Hilary
On Tue, Mar 21, 2023 at 3:55 PM hilary umans <hilary.umans> wrote:
Her achilles tendon is most normal, maybe mild chronic tendinosis depending if you are an over-caller.
There is this mass-like soft tissue thickening along the posterior/medial peritenon that’s not quite as dark at muscle on T1 and bright on PDFS.
She has that Tib Ant tenosynovitis, and she has P brevis tendinosis without tear (not shown).
I’ve not seen inflammation of the peritenon look so mass like.
What should I advise the referrer?
