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Long- and short-axis sonograms of the posterior heel in a patient with chronic heel pain (A and B). The Achilles tendon is seen in the near field as a thick
fibrillar structure in long axis (A) or speckled in short axis (B) just beneath the skin surface. The echogenic line beneath the tendon represents the posterior
surface of the calcaneus and the site of the Achilles tendon insertion. Between the Achilles tendon and the upper border of the calcaneus lies a hypoechoic
saclike structure that represents the retrocalcaneal bursa. The bursal sac extends somewhat above and around the superior edge of the calcaneus and
contains some echogenic debris within it, likely thickened synovium. In a second patient, the long-axis sonogram (C) shows a very thickened, enlarged,
hypoechoic retrocalcaneal bursa with synovial thickening extending around the superior edge of the calcaneus. Light transducer pressure is advised to
Source: Chapter 18. Musculoskeletal, Soft Tissue, and Miscellaneous Applications, Ma and Mateer's Emergency Ultrasound, 3e
avoid collapsing the bursa while scanning. The short-axis view should be used when an intrabursal steroid injection is planned. The injection needle should
Citation:
O, Mateer
Reardon
SA. Ma
and Mateer's
3e; 2014
Available
http://mhmedical.com/
be inserted from
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Accessed:
May
11,
2017
maximally reflective in this orientation since it will be nearly perpendicular to the insonating beam.
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