Acute medial Gastrocnemius tear with associated deep vein thrombosis: A case series and review of the literature

Christopher Lord1, Thomas Gibson1, Steve Baynes2, Mark Wotherspoon3, Leonard King1, 1Radiology, University Hospitals, Southampton NHS Foundation Trust, 2Sports Medicine, Southampton Football Club, 3Sports Medicine Nuffield Health

Acute exercise related medial calf pain is a common clinical problem and often presents in middle-aged patients following sporting activity including tennis, badminton and netball etc. The symptoms frequently relate to an acute tear of the medial head of gastrocnemius, however the differential diagnosis includes other muscle injuries involving soleus or plantaris, rupture of a Bakers’ cyst and deep vein thrombosis. Ultrasound is often the diagnostic modality of first choice and can help distinguish between the main differential diagnoses. In the presence of an acute muscle tear, ultrasound can be used to assess the grade of injury and associated complications including haematoma formation. We present three cases of medial gastrocnemius tears in middle-aged athletes (mean age 52 years) diagnosed by ultrasound with simultaneous demonstration of an associated intramuscular deep vein thrombosis. None of these cases demonstrated proximal propagation into the popliteal vein. The clinical features, imaging findings and management are presented in this case series along with a review of the published literature. We suggest that the presence of a medial gastrocnemius tear should routinely prompt ultrasound assessment of the adjacent deep calf veins to exclude intercurrent DVT.

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