There is significant thickening and marked heterogeneity of the distal aspect of the Achilles tendon at the calcaneal insertion. The tendon measures up to 16 mm in AP dimension.There are multiple echogenic foci of variable sizes with posterior acoustic shadowing evident consistent with florid calcifications. There is significant tendon hypervascularity on Doppler interrogation. The Achilles tendon otherwise appears intact. There is no posterior calcaneal spur demonstrated. There is inflammation of the retro-calcaneal bursa.
The features are most in keeping with Achilles intratendinous gouty tophus.
Correlation with blood uric acid is recommended. There are appearances of retrocalcaneal calcaneal bursa.