Sonographical Diagnosis of a late infection after an Achilles'tendon suture

Problemstellung: A sonographic evaluation can be utilized in making the primary diagnosis of Achilles tendon ruptures, as well as in follow up examinations after operative treatment of this condition. However, there is a paucity of literature describing the use of sonography to document a post-operative infection following suture repair. We are reporting on the sonographic diagnosis of a late infection following surgical care of a rupture of a degenerative, previously damaged Achilles tendon.

Patienten und Methode: We report on a 40 year old female patient, who was diagnosed with cellulitis on the right posterior leg. One year after operative treatment of an Achilles tendon rupture. During the clinical examination a fluctuant swelling was present in the area of the Achilles tendon with erythema from the heel to the popliteal region. On examination, the ankle joint moved freely with full range of motion equal to the other side. There was full strength in dorsiflexion and plantarflexion against resistance. The patient was able to ambulate without difficulty or pain prior to presentation.

Ergebnisse: In the central part of the tendon a 2×1cm area of low intensity with sediment present in the dependent portion was visible. In the dynamic examination, this could be positively indentified as a fluid collection. The color duplex sonography examination revealed hyperaemia in the surrounding area. Centrally in this fluid collection, there was an area of bright echo reflexes with dorsal acoustic shadows corresponding to scar tissue.

Schlussfolgerungen: With ultrasound accumulations of body fluids can be positively diagnosed post-operatively following Achilles tendon repair.