Achilles enthesitis and retrocalcaneal bursitis
10 year history of Achilles tendinopathy. Presents with ankle swelling.
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Mid to distal Achilles tendinopathy with undersurface delamination, and partial tearing at its insertion.
Moderate subcortical marrow hyperintensity and bone erosions at the tendon insertion in keeping with enthesitis.
Insertional Achilles tendinopathy with bone erosion and reactive marrow hyperintensity is compatible with enthesitis. Associated bursitis, paratenonitis, and adjacent fat pad edema reflect inflammation.
The possibility of an underlying seronegative spondyloarthropathy requires consideration. Look for evidence of synovitis/capsulitis, periarticular erosion, and tenosynovitis elsewhere (not present in this case).