Presentation
Presenting with a painless bilateral posterior ankle masses.
Patient Data
Diffuse bilateral right greater than left lobular fusiform thickening of the distal Achilles tendon measuring 2.5 cm on the right and 2 cm on the left in maximum thickness is most compatible with Achilles tendon xanthomas in this patient with bilateral painless posterior ankle masses.
The overlying skin is intact. No abnormal calcifications. No ankle joint effusion on either side. The osseous structures of the ankles are intact. The bone density is normal.
Case Discussion
Xanthomas are nodular lipid deposits in skin, tendons, and fascia that is a result of extremely high levels of triglycerides or LDL. This results in extravasation of plasma lipoproteins and ultimate deposition in tissues. Different types of xanthomas exist such as eruptive, tuberous, tendinous, palmar, and plane xanthomas. In particular, tendinous xanthomas commonly occur on the extensor tendons of hands and Achilles tendon. Patients presenting with xanthomas should be clinically assessed along with appropriate diagnostic laboratories, such as a lipid profile, to rule out hypercholesteremia, genetic syndromes, and metabolic conditions.
This case was submitted with supervision and input from:
Soni C. Chawla, M.D.
Health Sciences Clinical Professor,
Department of Radiological Sciences,
David Geffen School of Medicine at UCLA.
Attending Pediatric Radiologist,
Olive View - UCLA Medical Center.