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Age / Sex : /
Age / Sex : 65/M
Chief complaint: Right leg painful swelling
1) What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case.
* Send Application Answers to Ja-Young Choi, MD ([email protected])
Courtesy : Ji Young Hwang, MD. School of Medicine, Ewha Womans University
Diagnosis: Tennis leg (Plantaris rupture with hematoma)
Discussion
Findings:
The T2-weighted image shows the high signal intensity mass between soleus and medial head of gastrocnemius muscle at the upper calf level. Internal low signal intensity within the mass represents hemosiderin component. There is associated edema of the soleus muscle. The T1-weighted image shows isosignal intensity. There is thin walled peripheral enhancement on Gd-enhanced image.
Differential Diagnosis:
1. plantaris rupture with hematoma
2. soleus or gastrocnemius partial tear with hematoma
3. deep vein thrombosis
Diagnosis: plantaris rupture with hematoma (Tennis leg)
Discussion:
Tennis leg typically occurs in middle-aged persons with extension of the knee and forced dorsiflexion of the ankle. Sudden pain is felt in the calf, and patients often report a “pop” in the calf or a feeling as though someone has kicked the back of their leg. Swelling usually develops during the following 24 hours. The pathogenesis of tennis leg has been debated. Recently, some investigators report that partial tear of the medial gastrocnemius muscle appears to be more common than those of the plantaris tendon. MRI and US findings are 1) tubular hematoma between medial head of gastrocnemius and soleus muscle, 2) increased signal intensity in the plantaris muscle or myotendinous junction, 3) myotendinous rupture with proximal retraction of the plantaris muscle. Hyperintense edema usually exists within adjacent medial gastrocnemius and/or soleus muscle. Top differential diagnoses of plantaris rupture are gastrocnemius-soleus muscle strain or partial tear, deep vein thrombosis, and posterior compartment syndrome. Proximal plantaris tendon tear can be associated with ACL injury or posterolateral corner injury.
References:
1. Tennis Leg: clinical US study of 141 patients and anatomic investigation of four cadavers with MR imaging and US. Radiology 2002; 224:112–119.
2. Bencardino JT, Rosenberg ZS, Brown RR, Hassankhani A, Lustrin ES, Beltran J. Traumatic musculotendinous injuries of the knee: diagnosis with MR imaging. RadioGraphics 2000; 20:103–120.
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