Ultrasound Case 096

Presentation

A 40 year old man presents describing sudden calf pain that occurred when he was playing tennis.

View 2: Transverse calf running from proximal to distal
View 3: Longitudinal view
View 4: Panoramic longitudinal view of calf
Ultrasound Case 096 04 Panoramic long calf

Describe and interpret these scans

IMAGE INTERPRETATION

Image 1 and 2: Transverse views of the calf running from proximal to distal.

There is an elongated cylindrical shaped (“cigar-shaped”) hypoechoic collection lying between the bodies of the gastrocnemius muscle above and soleus muscle below.

The images also demonstrate some echogenic material in the gastrocnemius veins however these veins were easily compressible and became hypoechoic with foot movement – indicating stasis without thrombus.

Ultrasound Case 096 Key to image 1

Image 3: Longitudinal view of the same hypoechoic collection.

This is typical of plantaris muscle / tendon rupture, where blood accumulates in the inter fascial plane surrounding the injured plantaris tendon. Rupture tends to occur at the myotendinous junction.

Image 4: Panoramic longitudinal view of the calf demonstrating the fluid collection around the ruptured plantaris tendon.


CLINICAL CORRELATION

Plantaris muscle / tendon rupture

Calf pain is a common presentation to the Emergency Department. A history eliciting sudden onset during activity narrows the diagnosis. Having said this pain of musculoskeletal origin often leads to reduced mobility and venous thrombosis may be a consequence of injury.

The most common differentials of sudden onset provoked calf pain include Achilles tendon rupture, muscle tear (particularly the medial head of gastrocnemius), plantaris rupture and Baker’s cyst rupture.

Distal deep vein thrombosis not infrequently coexists and should be considered particularly if pain and swelling worsen a few days post injury.

References:


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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 |

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