Presentation
Left Achilles tendon region trauma one year before the presentation. Complaining of local pain.
The asymptomatic right Achilles tendon is intact with a normal echo pattern.
The symptomatic left Achilles tendon shows a complete tear with a gap between two edges measuring more than 30 mm. The distal tendon shows thickening and hypoechoic echo pattern favoring tendinosis.
On the lateral comparison view, the asymptomatic right Achilles tendon shows a homogeneous density and sharp margins.
The symptomatic left tendon shows focal thickening and irregular contour due to the tendon tear with retracted edges. The dorsal fat pad (Kager triangle) is not opacified in the absence of fluid due to chronic injury.
Case Discussion
Both radiograph and ultrasound findings are characteristic of Achilles tendon tear.
If findings are equivocal comparison to the asymptomatic side is recommended.
Obtaining good quality panoramic view US images requires experience, but this better demonstrates pathology affecting elongated structures such as tendons.
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