#30391
Stephen Bird
Keymaster

HI Xue,

Tricky one !

The question in my mind is “did the tree fall cause the pathology or was that event a coincidence”

If the tree fall had nothing to do with it we could be looking at a rheumatoid patient.

But you said there was a hyperechoic free body. Did this look like a foreign body?

If it was a splinter from the tree are we looking at a chronic infection?

There is certainly a lot of inflammation in the soft tissues. The question is whether it is synovial proliferation from something like rheumatoid or a chronic infection from the fall.

he extender digitorum brevis muscle is lateral to this location so I don’t think it has anything to do with it.

There is a bursa under the tib ant tendon and it could be a chronic bursitis of that bursa.

It looks like it is getting worse as I notice you have sent me films from 2 dates.

So :

Rheumatoid
Gout
Foreign body – chronic infection
Bursitis

Steve

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