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Fluid Mass in calf

Exit forum ID Forum Discussion Fluid Mass in calf

This topic contains 2 replies, has 2 voices, and was last updated by   Andrew Wengert June 4, 2019 at 10:08 pm.

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  • #7150

    Andrew Wengert
    Participant

      57-year-old female.
      Pain location is medial head of the right gastroc. Quality is sharp shooting and “extremely sensitive”.
      Intensity is a 7/10 currently, 7/10 average, 10/10 worst.
      Provocative includes touching it or bumping it or compression. Also quick movements flexing or extending the knee. Loaded plantarflexion. Also being in heels or going for a long walk or run.
      Rest or unloading is palliative.

      All of the lower extremity assessments were full and pain-free with the exception of passive knee flexion which was three fingers blocked by pain due to compression of the hamstring and the tender calf muscle. Knee flexion hip extension was also limited to 4 fingers for the same reason.
      PK test was also Painful due to the compression on the calf but ankle plantar flexion was full. Lock out was full with two legs but with loading the right leg severely limited due to pain. Have the patient stand on a step and drop into dorsiflexion with the knee extended was painful.

      Palpating of the area of chief complaint is extremely painful. Adhesion in the gastroc graded a 1.

      MRI impression reads as follows:

      Subtle small density between the medial head gastrocnemius and soleus muscles with trace fluid at the inferior aspect. This is within the expected location of the gastrocnemius muscle T2 hyperintense focus seen on prior MRI’s and is favored to represent complex fluid or hematoma and possibly representing acute or chronic tennis leg.

      The patient has been dealing with this since 2015 and it has progressively gotten worse.
      She did have vein surgery in 2014 in that exact same area.

      What type of specialist should this person be referred to to address the fluid in the calf?

      #7154

      Keith Puri, DC
      Participant

        I did a quick PubMed search and came across a case report with near identical findings your to patient’s MRI that was successfully tx by removing the hematoma endoscopically.

        I am not exactly sure which type of surgeon would perform this procedure? However, given her PMH of vein surgery to that area, a follow-up to the vascular surgeon who would be my recommendation.

        https://www.ncbi.nlm.nih.gov/pubmed/16904602

        #7155

        Andrew Wengert
        Participant

          Thank you for finding this and sharing it!

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