整形２９

【臨床症状】50代　ランニング中の痛み

【問題】画像所見と診断名は？

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※ T2*、プロトン強調、脂肪抑制画像の順に表示

    ▶答えはこちら
    • 各種シーケンスでアキレス腱に紡錘状の腫大あり
    • アキレス腱自体に断裂などの所見はなし
    • またKager's fat padに脂肪抑制で高信号を認める
    • 上記よりアキレス腱炎、もしくはアキレス腱周囲炎が疑われた

    【アキレス腱炎/アキレス腱周囲炎】

    ・アキレス腱はパラテノンと呼ばれる薄い膜で覆われており、このパラテノンに炎症が起きた状態

    ・若年スポーツ者に限らず中高年にも発症する

    ・アキレス腱炎はスポーツ競技歴が長い人に多い傾向がある

    ・原因はアキレス腱（もしくはその周囲）に繰り返し伸張刺激が加わる事で、結合組織の炎症や腱実質に微細損傷や変性を起こす事と言われている

    ・主な症状はアキレス腱の伸張位での疼痛

    ・画像所見は腱実質の腫大や腱内部に高信号を認める

    ・基本は保存療法だが、症状によっては外科的治療が行われることもある