Ultrasound Cases Logo
Search Cases

Case of the Month

June 2009

Patient Data: 50 year old male

Clinical Info: Felt a sudden snap in the calf during kickboxing four weeks ago. There is not much clinical improvement and there is still a painful swelling of the calf.


24787.jpg
Longitudinal image of the calf with an anechoic structure between the medial gastrocnemius and the soleus muscle.


24788.jpg
Transverse image of the same anechoic structure between the medial gastrocnemius an the soleus muscle. The differential diagnosis of a fluid collection between the medial gastrocnemius and the soleus muscle include a hematoma caused by a gastrocnemius muscle rupture, a hematoma caused by a plantaris tendon rupture and a ruptured Baker's cyst. To make the differentiation it is important to examine the fluid collection in its full length.


31486-24789.jpg
The extended field of view is very helpful to visualize the entire length of a lesion. The lesion was over 13 cm long and had no relation with the knee space


24790.jpg
This longitudinal image however shows a rupture with slight retraction of the stump(arrow) surrounded by a hematoma at the distal end of the medial gastrocnemius muscle.


24791.jpg
This transverse image shows a rupture with slight retraction of the stump(arrow) surrounded by a hematoma at the distal end of the medial gastrocnemius muscle. In an uncomplicated case of a medial gastrocnemius muscle rupture or so called tennis leg, the clinical symptoms should diminish in a few weeks time. That is not the case in this patient. Therefore the examination was continued and this non compressible hypoechoic tubular structure was found.


24792.jpg
Longitudinal image of the medial gastrocnemius muscle with a non compressible hypoechoic tubular structure.


24793.jpg
Longitudinal image of the same tubular structure in the medial gastrocnemius muscle slightly more proximal. There is a local widening of the structure. The arrows point to the immobile valves in this thrombus filled vein.


24794.jpg
Transverse image of the medial gastrocnemius muscle with non compressible thrombus filled veins. The thrombosis of the gastrocnemius veins were a complication of the gastrocnemius rupture and could explain the impaired recovery. In the case of venous thrombosis it is important to examine the extent of the thrombosis. In this patient the thrombus filled gastrocnemius veins could be followed all the way to the knee space.


24795.jpg
Transverse image of the popliteal vessels. The popliteal vein is the more superficial structure. The artery is anechoic. But the vein shows an echogenic intraluminal structure (arrow).


24796.jpg
Longitudinal image of the popliteal vessels. The arrow points to a thrombus mass extending into the popliteal vein.

Because of the extent of the thrombosis, the patient was treated with anticoagulant therapy.

The combination of a deep venous thrombosis and a medial gastrocnemius rupture was first described in 1994.

For more examples of muscle ruptures or gastrocnemius vein thrombosis see

References
Slawski DP. Deep venous thrombosis complicating rupture of the medial head of the gastrocnemius muscle. J Orthop Trauma. 1994;8(3):263-4.

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.

Developed by Prominent Media Web Development