Achilles tendon xanthomata are painless soft tissue masses occurring most commonly at the distal portion of the Achilles tendon and are usually bilateral and symmetrical.
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Pathology
Localized accumulation of lipid-laden macrophages is characteristic, inflammatory cells and giant cells secondary to cholesterol deposition in tissue.
Etiology
type 2 and 3 hypoproteinaemias
Radiographic features
Plain radiograph
thickening of the Achilles tendon
no calcifications
other tendon or periarticular soft tissue nodularity may be present
often bilateral and symmetrical
Ultrasound
an AP thickness of the tendon >7 mm in males and >6 mm in females
tendon is more uniformly thickened as opposed to fusiform as seen in tendinopathy
loss of normal tendon appearance with multiple hypoechoic foci within the tendon but not fluid dark
often bilateral and symmetric
other ankle flexor and extensor tendons can be involved
MRI
Shows increased AP diameter of the distal tendon which is often uniform, not fusiform. Loss of the normal anterior concavity of the tendon can also be seen.
Signal characteristics
intermediate signal on T1 and T2 sequences
higher T1 and T2 signal compared to the normal tendon
T2 signal will not be 'fluid' bright as seen in partial-thickness tears 4
striated appearance in sagittal sequences due to interposition of xanthoma between normal tendon fibers 4,5
speckled appearance of the tendon in axial sequences
Other features include:
often bilateral and symmetric
other ankle flexor and extensor tendons can be involved
Differential diagnosis
chronic tendon degeneration (e.g. mucoid)
partial-thickness tears