PMC6083480_01
Preoperative anterior-posterior and lateral radiographs of the left ankle joint showing no signs of any osseous destruction or joint damage.
CRIOR2018-8790916.001.jpg
PMC6083480_01_CRIOR2018-8790916.001.jpg
fig1
Anterioposterior and lateral X-rays of the ankle joint did not show any signs of osteoarthritis or other osseous destruction (Figure 1).
T2-weighted axial magnetic resonance images demonstrating a soft tissue tumor along and around the peroneal tendons with hypo- and hyperintense central areals and an inhomogenous, diffuse uptake of the contrast agent (arrows), highly suspicious for a synovial sarcoma.
CRIOR2018-8790916.002.jpg
PMC6083480_01_CRIOR2018-8790916.002.jpg
fig2
MRI revealed a lesion of size of 4.3 x 2.7 x 3.7 cm in close relation to the peroneal tendons with hypo- and hyperintense central areals, especially in the inframalleolar area, and an inhomogenous, diffuse uptake of the contrast agent, highly suspicious for a synovial sarcoma (Figure 2).
Exposure of the tophaceous lesion after opening of the tendinous sheath of the peroneal tendons.
CRIOR2018-8790916.003.jpg
PMC6083480_01_CRIOR2018-8790916.003.jpg
fig3
After opening of the tendinous sheath of both peroneal tendons, the tophaceous lesion was exposed (Figure 3).
The excised tophus.
CRIOR2018-8790916.004.jpg
PMC6083480_01_CRIOR2018-8790916.004.jpg
fig4
The lesion was then excised from proximal to distal (Figure 4).
Following excision of the tophus, the gout infiltration of the tendons was evident.
CRIOR2018-8790916.005.jpg
PMC6083480_01_CRIOR2018-8790916.005.jpg
fig5
Both tendons of the peroneus brevis and longus were then prepared along their entire course and debrided from any remaining tophaceous infiltration (Figures 5 and 6).
The tendons of the peroneus brevis and longus were prepared along their entire course and debrided from all tophaceous infiltration.
CRIOR2018-8790916.006.jpg
PMC6083480_01_CRIOR2018-8790916.006.jpg
fig6
Both tendons of the peroneus brevis and longus were then prepared along their entire course and debrided from any remaining tophaceous infiltration (Figures 5 and 6).