Rheumatoid nodules of paratenon
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Patient with known diagnosis of rheumatoid arthritis. Multiple hypoechoic nodules adjacent to tendons in different locations on patient's body were found. The nodules are seen in the mid aspect of both Achilles' tendons at the posterior aspect, most likely originate from tendon sheath (paratenon). There is no or vague activity seen on Power Doppler. I noted that the patient is on biological treatment, which may differ the radiological appearance of these lesions. The appearances are consistent with rheumatoid nodules, which are external to the tendon. These are not related to subcutaneous connective tissue. Another typical region of paratenon rheumatoid nodules origin is the triceps insertion into the olecranon and there are also similar nodules there. Smaller nodules are also noted adjacent to the fascia of the palmar aspect of both hands.
The patient is known to have long-standing rheumatoid arthritis and previous resection of similar nodules from the left olecranon region. Histopathology confirmed a rheumatoid nodule. There is no significant activity of the synovial disease, most likely due good response to biological treatment. Unfortunately, nodular lesions progress in different locations of the body.