Multiple tendinous xanthomata in familial hypercholesterolemia
Updates to Case Attributes
The association of tendinous xanthomata (including Achilles tendon xanthomas) with familial hypercholesterolemia (FH) has been well recognized [1]. In FH there is a reduction in functionally active LDL receptors, thus its metabolism and excretion, resulting abnormal deposition of cholesterol in soft tissues and blood vessels [1].
Deposition of lipid laden macrophages (foam cells) in tendons results in formation of tendinous xanthomata. They are commonly seen in Achilles tendons, extensor tendons of hands and feet, and in triceps tendons [1, 3]. Studies have shown that cholesterol-lowering statins can also lessen the size of tendinous xanthomas. These lesions are usually bilateral and painless [1], but can sometimes be painful and itchy.
Radiography of ankles reveals bilateral well defined non-calcified soft tissue swelling, without osseous or joint abnormalities.
Ultrasonography using a high resolution linear-array probe, showshows marked nodular enlargement and mix echo texturemixed echotexture of affected tendons with hypoechoic nodules representing xanthoma [5].
Fusiform enlargement of affected tendontendons with vertical striations of high and low signal can be seen in T1W and T2W MR Images. MRI features of tendon xanthomata, although characteristic diagnostic overlap occurs with partial tendon tears and tendinopathies [2]. MRI imaging features can be seen even before clinically detectable tendon enlargement [3]. Our
Our patient shows the classical radiological imaging characteristics of tendinous xanthomata of Achilles and tibialis posterior and triceps tendons.
-<p>The association of tendinous xanthomata with familial hypercholesterolemia (FH) has been well recognized [1]. In FH there is a reduction in functionally active LDL receptors thus its metabolism and excretion, resulting abnormal deposition of cholesterol in soft tissues and blood vessels [1].<br>Deposition of lipid laden macrophages (foam cells) in tendons results in formation of tendinous xanthomata. They are commonly seen in Achilles tendons, extensor tendons of hands and feet and in triceps tendons [1, 3]. Studies have shown that cholesterol-lowering statins can also lessen the size of tendinous xanthomas. These lesions are usually bilateral and painless [1], but can sometimes be painful and itchy.</p><p>Radiography of ankles reveals bilateral well defined non-calcified soft tissue swelling, without osseous or joint abnormalities. Ultrasonography using high resolution linear-array probe, show marked nodular enlargement and mix echo texture of affected tendons with hypoechoic nodules representing xanthoma [5].<br>Fusiform enlargement of affected tendon with vertical striations of high and low signal can be seen in T1W and T2W MR Images. MRI features of tendon xanthomata, although characteristic diagnostic overlap occurs with partial tendon tears and tendinopathies [2]. MRI imaging features can be seen even before clinically detectable tendon enlargement [3].<br> Our patient shows the classical radiological imaging characteristics of tendinous xanthomata of Achilles and tibialis posterior and triceps tendons.</p><p> </p><p> </p>- +<p>The association of tendinous xanthomata (including <a title="achilles tendon xanthomatosis" href="/articles/achilles-tendon-xanthoma">Achilles tendon xanthomas</a>) with familial hypercholesterolemia (FH) has been well recognized [1]. In FH there is a reduction in functionally active LDL receptors, thus its metabolism and excretion, resulting abnormal deposition of cholesterol in soft tissues and blood vessels [1].</p><p>Deposition of lipid laden macrophages (foam cells) in tendons results in formation of tendinous xanthomata. They are commonly seen in Achilles tendons, extensor tendons of hands and feet, and in triceps tendons [1, 3]. Studies have shown that cholesterol-lowering statins can also lessen the size of tendinous xanthomas. These lesions are usually bilateral and painless [1], but can sometimes be painful and itchy.</p><p>Radiography of ankles reveals bilateral well defined non-calcified soft tissue swelling, without osseous or joint abnormalities.</p><p>Ultrasonography using a high resolution linear-array probe, shows marked nodular enlargement and mixed echotexture of affected tendons with hypoechoic nodules representing xanthoma [5].</p><p>Fusiform enlargement of affected tendons with vertical striations of high and low signal can be seen in T1W and T2W MR Images. MRI features of tendon xanthomata, although characteristic diagnostic overlap occurs with partial tendon tears and tendinopathies [2]. MRI imaging features can be seen even before clinically detectable tendon enlargement [3].</p><p>Our patient shows the classical radiological imaging characteristics of tendinous xanthomata of Achilles and tibialis posterior tendons.</p>
References changed:
- 1. Schweitzer ME, Karasick D. MR imaging of disorders of the Achilles tendon. AJR Am J Roentgenol. 2000;175 (3): 613-25. <a href="http://dx.doi.org/10.2214/ajr.175.3.1750613">doi:10.2214/ajr.175.3.1750613</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/10954440">Pubmed citation</a><span class="ref_v3"></span>
- 1. Schweitzer ME, Karasick D. MR imaging of disorders of the Achilles tendon. AJR Am J Roentgenol. 2000;175 (3): 613-25. <a href="http://dx.doi.org/10.2214/ajr.175.3.1750613">doi:10.2214/ajr.175.3.1750613</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/10954440">Pubmed citation</a><span class="ref_v3"></span>
- 2. Bude RO, Adler RS, Bassett DR. Diagnosis of Achilles tendon xanthoma in patients with heterozygous familial hypercholesterolemia: MR vs sonography. AJR Am J Roentgenol. 1994;162 (4): 913-7. <a href="http://dx.doi.org/10.2214/ajr.162.4.8141017">doi:10.2214/ajr.162.4.8141017</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/8141017">Pubmed citation</a><span class="auto"></span>
- 2. Bude RO, Adler RS, Bassett DR. Diagnosis of Achilles tendon xanthoma in patients with heterozygous familial hypercholesterolemia: MR vs sonography. AJR Am J Roentgenol. 1994;162 (4): 913-7. <a href="http://dx.doi.org/10.2214/ajr.162.4.8141017">doi:10.2214/ajr.162.4.8141017</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/8141017">Pubmed citation</a><span class="auto"></span>
- 2. Bude RO, Adler RS, Bassett DR. Diagnosis of Achilles tendon xanthoma in patients with heterozygous familial hypercholesterolemia: MR vs sonography. AJR Am J Roentgenol. 1994;162 (4): 913-7. <a href="http://dx.doi.org/10.2214/ajr.162.4.8141017">doi:10.2214/ajr.162.4.8141017</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/8141017">Pubmed citation</a><span class="auto"></span>
- 2. Bude RO, Adler RS, Bassett DR. Diagnosis of Achilles tendon xanthoma in patients with heterozygous familial hypercholesterolemia: MR vs sonography. AJR Am J Roentgenol. 1994;162 (4): 913-7. <a href="http://dx.doi.org/10.2214/ajr.162.4.8141017">doi:10.2214/ajr.162.4.8141017</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/8141017">Pubmed citation</a><span class="auto"></span>
- 3. Descamps OS, Leysen X, Van Leuven F et-al. The use of Achilles tendon ultrasonography for the diagnosis of familial hypercholesterolemia. Atherosclerosis. 2001;157 (2): 514-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11472754">Pubmed citation</a><span class="auto"></span>
- 3. Descamps OS, Leysen X, Van Leuven F et-al. The use of Achilles tendon ultrasonography for the diagnosis of familial hypercholesterolemia. Atherosclerosis. 2001;157 (2): 514-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11472754">Pubmed citation</a><span class="auto"></span>
- 3. Descamps OS, Leysen X, Van Leuven F et-al. The use of Achilles tendon ultrasonography for the diagnosis of familial hypercholesterolemia. Atherosclerosis. 2001;157 (2): 514-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11472754">Pubmed citation</a><span class="auto"></span>
- 3. Descamps OS, Leysen X, Van Leuven F et-al. The use of Achilles tendon ultrasonography for the diagnosis of familial hypercholesterolemia. Atherosclerosis. 2001;157 (2): 514-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11472754">Pubmed citation</a><span class="auto"></span>
- 3. Descamps OS, Leysen X, Van Leuven F et-al. The use of Achilles tendon ultrasonography for the diagnosis of familial hypercholesterolemia. Atherosclerosis. 2001;157 (2): 514-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11472754">Pubmed citation</a><span class="auto"></span>
- 4. Dagistan E, Canan A, Kizildag B et-al. Multiple tendon xanthomas in patient with heterozygous familial hypercholesterolaemia: sonographic and MRI findings. BMJ Case Rep. 2013;2013 (nov19 1): . <a href="http://dx.doi.org/10.1136/bcr-2013-200755">doi:10.1136/bcr-2013-200755</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/24252837">Pubmed citation</a><span class="auto"></span>
- 4. Dagistan E, Canan A, Kizildag B et-al. Multiple tendon xanthomas in patient with heterozygous familial hypercholesterolaemia: sonographic and MRI findings. BMJ Case Rep. 2013;2013 (nov19 1): . <a href="http://dx.doi.org/10.1136/bcr-2013-200755">doi:10.1136/bcr-2013-200755</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/24252837">Pubmed citation</a><span class="auto"></span>
- 4. Dagistan E, Canan A, Kizildag B et-al. Multiple tendon xanthomas in patient with heterozygous familial hypercholesterolaemia: sonographic and MRI findings. BMJ Case Rep. 2013;2013 (nov19 1): . <a href="http://dx.doi.org/10.1136/bcr-2013-200755">doi:10.1136/bcr-2013-200755</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/24252837">Pubmed citation</a><span class="auto"></span>
- 1. Meehyun Park, Ik Yang, Hyun Suk Cho, multiple xanthomas in patient with familial hypercholesteremia: J Korean Soc Radiol 2014;71(3):146-149 2. Schweitzer ME, Karasick D. MR imaging of disorders of the Achilles tendon. AJR 2000;175:613-625 3. Elaine S. Gould, Anthony Gilet, M., and Alex Dagum et al.: Multitendon xanthomatosis in a normo-cholesterolemic patient. Radiology Case Reports. 2009;5:381 4. Descamps OS, Leysen X, Van Leuven F, Heller FR. The use of Achilles tendon ultrasonography for the diagnosis of familial hypercholesterolemia. Atherosclerosis 200; 157:514–518. 5. Bude RO, Adler RS, Bassett DR. Diagnosis of Achilles tendon xanthoma in patients with heterozygous familial hypercholesterolemia: MR vs sonography. AJR Am J Roentgenol 1994; 162:913–917.
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- 1. Meehyun Park, Ik Yang, Hyun Suk Cho, multiple xanthomas in patient with familial hypercholesteremia: J Korean Soc Radiol 2014;71(3):146-149 3. Elaine S. Gould, Anthony Gilet, M., and Alex Dagum et al.: Multitendon xanthomatosis in a normo-cholesterolemic patient. Radiology Case Reports. 2009;5:381 4. Descamps OS, Leysen X, Van Leuven F, Heller FR. The use of Achilles tendon ultrasonography for the diagnosis of familial hypercholesterolemia. Atherosclerosis 200; 157:514–518. 5. Bude RO, Adler RS, Bassett DR. Diagnosis of Achilles tendon xanthoma in patients with heterozygous familial hypercholesterolemia: MR vs sonography. AJR Am J Roentgenol 1994; 162:913–917.
- 1. Meehyun Park, Ik Yang, Hyun Suk Cho, multiple xanthomas in patient with familial hypercholesteremia: J Korean Soc Radiol 2014;71(3):146-149 3. Elaine S. Gould, Anthony Gilet, M., and Alex Dagum et al.: Multitendon xanthomatosis in a normo-cholesterolemic patient. Radiology Case Reports. 2009;5:381 4. Descamps OS, Leysen X, Van Leuven F, Heller FR. The use of Achilles tendon ultrasonography for the diagnosis of familial hypercholesterolemia. Atherosclerosis 200; 157:514–518.
- 1. Meehyun Park, Ik Yang, Hyun Suk Cho, multiple xanthomas in patient with familial hypercholesteremia: J Korean Soc Radiol 2014;71(3):146-149 3. Elaine S. Gould, Anthony Gilet, M., and Alex Dagum et al.: Multitendon xanthomatosis in a normo-cholesterolemic patient. Radiology Case Reports. 2009;5:381
- 3. 5. Bude RO, Adler RS, Bassett DR. Diagnosis of Achilles tendon xanthoma in patients with heterozygous familial hypercholesterolemia: MR vs sonography. AJR Am J Roentgenol 1994; 162:913–917.
- 3. Bude RO, Adler RS, Bassett DR. Diagnosis of Achilles tendon xanthoma in patients with heterozygous familial hypercholesterolemia: MR vs sonography. AJR Am J Roentgenol 1994; 162:913–917.
- 3. Bude RO, Adler RS, Bassett DR. Diagnosis of Achilles tendon xanthoma in patients with heterozygous familial hypercholesterolemia: MR vs sonography. AJR Am J Roentgenol. 1994;162 (4): 913-7. <a href="http://dx.doi.org/10.2214/ajr.162.4.8141017">doi:10.2214/ajr.162.4.8141017</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/8141017">Pubmed citation</a><span class="auto"></span>
- 3.
- 3. Descamps OS, Leysen X, Van Leuven F et-al. The use of Achilles tendon ultrasonography for the diagnosis of familial hypercholesterolemia. Atherosclerosis. 2001;157 (2): 514-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11472754">Pubmed citation</a><span class="auto"></span>
- 3. Meehyun Park, Ik Yang, Hyun Suk Cho, multiple xanthomas in patient with familial hypercholesteremia: J Korean Soc Radiol 2014;71(3):146-149
Tags changed:
- musculoskeletal
- xanthoma
- tendon
- achilles
Updates to Study Attributes
enlargementEnlargement and striated appearance of Achilles and tibialis posterior tendonstendons