Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword
- Preface
- Section 1 Shoulder
- Section 2 Arm
- Section 3 Elbow
- Section 4 Forearm
- Section 5 Wrist
- Section 6 Hand
- Section 7 Hip and Pelvis
- Section 8 Thigh
- Section 9 Leg
- Section 10 Ankle
- Case 60 Posterior impingement
- Case 61 Haglund’s syndrome
- Case 62 Accessory anterolateral facet of the talus
- Case 63 Maisonneuve fracture
- Case 64 Triplane fracture
- Case 65 Peroneal tendon dislocation and calcaneal fractures
- Case 66 Anterior impingement
- Case 67 Peroneocalcaneus internus muscle: false flexor hallucis longus (FHL)
- Case 68 Accessory soleus muscle: a differential for posteromedial ankle mass
- Case 69 Xanthoma of the Achilles tendon
- Section 11 Foot
- Section 12 Tumors/Miscellaneous
- Index
- References
Case 69 - Xanthoma of the Achilles tendon
from Section 10 - Ankle
Published online by Cambridge University Press: 05 July 2013
- Frontmatter
- Contents
- List of contributors
- Foreword
- Preface
- Section 1 Shoulder
- Section 2 Arm
- Section 3 Elbow
- Section 4 Forearm
- Section 5 Wrist
- Section 6 Hand
- Section 7 Hip and Pelvis
- Section 8 Thigh
- Section 9 Leg
- Section 10 Ankle
- Case 60 Posterior impingement
- Case 61 Haglund’s syndrome
- Case 62 Accessory anterolateral facet of the talus
- Case 63 Maisonneuve fracture
- Case 64 Triplane fracture
- Case 65 Peroneal tendon dislocation and calcaneal fractures
- Case 66 Anterior impingement
- Case 67 Peroneocalcaneus internus muscle: false flexor hallucis longus (FHL)
- Case 68 Accessory soleus muscle: a differential for posteromedial ankle mass
- Case 69 Xanthoma of the Achilles tendon
- Section 11 Foot
- Section 12 Tumors/Miscellaneous
- Index
- References
Summary
Imaging description
Thickening of the predominantly low-signal intensity Achilles tendon (Figure 69.1) is seen with a speckled or reticulated appearance on the axial fat-suppressed T1-weighted MR images. Sonography also shows thickening of the Achilles tendon, which reveals focal or diffuse hypoechoic lesions consistent with xanthoma. Sonographic lesions demonstrate discrete or confluent nodules with loss of normal tendon (fibrillar) architecture.
Importance
Tendon xanthoma is a hallmark of familial hypercholesterolemia (FH), an autosomal dominant disorder affecting about one in 500 in the general population. The patients with FH are at risk of premature coronary arterial disease due to an elevated low-density lipoprotein (LDL) cholesterol level. Early recognition and treatment of FH is important as effective treatment to lower cholesterol has been introduced. Familial hypercholesterolemia can be screened and diagnosed by the triad of tendon xanthoma, hypercholesterolemia (type IIa), and a family history of premature atherosclerosis. Physical examination may not detect up to 20% of the patients with FH after age 20. Imaging study can play an important role in such occasions by demonstrating xanthoma of Achilles tendon.
Typical clinical scenario
A patient who is suspected of having FH and whose physeal examination of Achilles tendon is unremarkable may be referred to sonographic study or MRI for the detection of xanthoma of Achilles tendon. A remote study showed a better detection of xanthoma of Achilles tendon by sonography compared with MRI for 10 patients with FH. Less commonly, characteristic appearance in MRI may lead to the diagnosis of FH in whom such diagnosis has not been suspected. The extensor tendons of the fingers and patellar tendons are other common sites for development of xanthoma.
- Type
- Chapter
- Information
- Pearls and Pitfalls in Musculoskeletal ImagingVariants and Other Difficult Diagnoses, pp. 149 - 150Publisher: Cambridge University PressPrint publication year: 2013