Additional response, thanks!
I like this for complex intratendinous ganglion, Phil. To tie h/o past surgery, it could have been background mucoid degeneration with a seroma that grew out of control.
I have seen pretty large ganglia, not quite as big as this, within the substance of the PTT and peroneals.
My two cents.
On Tue, Jan 7, 2025 at 5:08 PM Phillip Tirman MD <ptirmanmd> wrote:
Thanks for the responses. A few asked about a xanthoma which I initially disocunted because I didn’t see the stripes of tendon tissue through the mass as has been described but I suppose it could be replaced like this.
Responses are:
Well all of what you stated, that is, mucoid deg gone crazy w/without component of hemorrhage. Gout/Amyloid but I would think you would have some kind of history.
Dear Philip,
Has there been previous surgery, calcaneal artefact is real? (yes there has been achilles surgery) I have messaged the surgeon and am awaiting call back.Aloha Phil.
When things are bright on T1 T2FS and dark on STIR, think proteinaceous fluid or blood products (I know you know this…).
My bet would be some sort of mega-mucinous Achilles degeneration. Obviously not xanthomatous? Other tendons look normal….Saavedra, L.A.B. A 5-year follow-up of Achilles tendon reconstruction using a full-thickness graft processed with the clearant method and retrograde fixation in the calcaneus: a case study of an amateur soccer player. J EXP ORTOP 10, 119 (2023). https://doi.org/10.1186/s40634-023-00690-0
Hi, I have only once seen something similar, but if was involved the plantar fascia also, and it was Xathoma of achilles tendon
Bellow – one of the few articles I could find….
https://pmc.ncbi.nlm.nih.gov/articles/PMC10289843/
Imaging fits at least partially, I think.Once surgery (or any human intervention) has ever been performed, watch out : humans may have had great ideas…
you can’t imagine what they might have wanted to do.
Some sort of metallosis ???
very low SI…
Thanks to all!
On Tue, Jan 7, 2025 at 10:31 AM Phillip Tirman MD <ptirmanmd> wrote:
Looking at this case which comes with the unhelpful and probably wrong history of juvenile osteochondrosis. Patient is a 75yoM, semi retired psychologist with Ankle pain. I will call for more history like when the surgery was performed, etc.
The expansile region within the achilles is intermediate on T1 and PD fat sat, dark on T2 and STIR. Is this mucoid, hemorrhagic, both, neither? I figure it should have a short T1 just not exactly where fat is on the spectrum in order for it not to saturate on the frequency selective fat sat (which looks pretty successful) axial sequence and to sat out nicely on STIR or am I totally wrong about that (probably as has happened repeatedly on OCAD)?
T1 Sagittal
T2 axial
PD Fat Sat Axial
Sag STIR
Thanks for any guidance.
Phillipbtw after embarrassing myself with the last attempt at ill conceived moderation, I thought I’d give AI a chance. This is what it said. Not ready for prime time.
On an MRI, a tissue appearing dark on both T2 and STIR sequences, while showing intermediate signal on T1 and PD with frequency selective fat saturation, is most likely water-based fluid like edema, as these sequences are designed to highlight fluid while suppressing the signal from fat, making the fat appear dark on T2 and STIR and the fluid appear relatively brighter on T1 and PD with fat saturation.
Key points to remember:
- T2 and STIR:
These sequences are highly sensitive to water content, so fluid will appear bright on these images.- T1 and PD with fat saturation:
While still showing some fluid signal, these sequences are more sensitive to fat content, which will appear bright when not suppressed.
