Ultrasound Case 088


I stepped off my back decking into a hole the dog had carefully manicured in the lawn. A combination of plantar flexion and inversion resulted in a rather swollen ankle you see in the first image. I managed it conservatively but at 6 weeks it still felt a bit boggy and unstable.

Ultrasound? Of course.

Ultrasound Top 100 LITFL ankle clinical image
View 2: Longitudinal ankle
View 3: Longitudinal anterior ankle
View 4: Long ankle with Doppler
View 5: Ankle longitudinal and transverse – still
Ultrasound Top 100 LITFL 088 04
ankle longitudinal still
Ultrasound Top 100 LITFL 088 05
ankle transverse still
View 6: Lateral ankle ATFL- still
Ultrasound Top 100 LITFL 088 06
lateral ankle ATFL

Describe and interpret these scans

Image 1: Clinical photograph

My ankle a few days post injury.

Image 2,3,4,5 anterior longitudinal image of the ankle joint.

This shows the anechoic effusion and if the best single view for finding and ankle effusion. Place the probe just lateral to extensor hallucis longus longitudinally, slide distally down the anterior tibia until you find the ankle joint. You with see the rounded articular surface of the talus. If there is an effusion you should see the boat shaped hypoechoic collection here. Fresh blood and pus can appear more echogenic.

Ultrasound Top 100 LITFL 088 key to images 1_4Ultrasound Top 100 LITFL 088 key to images 1_4

Image 6: Lateral ankle

Feeling sorry for myself I wondered if I could find my ATFL – anterior talofibular ligament.

Alas it had ruptured.

Ultrasound Top 100 LITFL 088 Key to image 6


Ankle effusion and ruptured anterior talofibular ligament (ATFL)

Findings joint effusions basically entail putting the ultrasound transducer where one would approach the joint with a needle using the traditional landmark aspiration techniques. This gives an image of the biggest pocket of joint fluid available.

The ankle joint lies anteriorly, with longitudinal probe placement. Aspiration can then be carried out with the transducer transversely, in plane, although there are a number of techniques.



Dr James Rippey LITFL Ultrasound SonoCPD

An Emergency physician based in Perth, Western Australia. Professionally my passion lies in integrating advanced diagnostic and procedural ultrasound into clinical assessment and management of the undifferentiated patient. Sharing hard fought knowledge with innovative educational techniques to ensure knowledge translation and dissemination is my goal. Family, wild coastlines, native forests, and tinkering in the shed fills the rest of my contented time. | SonoCPDUltrasound library | Top 100 | @thesonocave |


  1. Excellent case thanks, from someone who has sprained his ankle many times! I’ll definitely scan more ankles now

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