Achilles Paratendinitis?

[Diane]

Hi Stephen,

I scanned a female today with a Hx of Rheumatoid Arthritis. She presented with left achilles lump for investigation. (the lump was around 10cm away from the sole of the foot). Similarly, she had one as well on her asymptomatic right side.

I saw a hypoechoic area sitting superficial to the achilles tendon and appeared to move with the tendon upon dynamic assessment (cine provided).

I was thinking it was paratendinitis? Is there a specific name for this appearance?
The radiologist reported it as chronic paratendinitis? Granulation tissue from old injury (patient does not recall any injury)?

Would rheumatoid arthritis play any part in the Achilles tendon?

Thanks!

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[Stephen Bird]

Hi Diane,

This is in the correct area for paratendinitis and rheumatoid is certainly going to be a predisposing factor for such synovial proliferation.
The unusual thing about this one is it is focal and localised, more like a rheumatoid nodule of synovial proliferation compared to the more common diffuse paratendinitis appearance.
I still think it is the correct diagnosis but more rheumatoid nodule version of it.
The clip is great as part of the nodule is stuck to the tendon itself while the rest floats freely.
It almost flips on itself during dynamic movement.

Great case,

Steve

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