Images in Clinical Medicine

Achilles'-Tendon Xanthoma in Familial Hypercholesterolemia

Harrie C.M. van den Bosch, M.D., and Louwerens D. Vos, M.D.

N Engl J Med 1998; 338:1591May 28, 1998

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Figure 1 A 22-year-old woman with a family history of hypercholesterolemia had had a soft-tissue swelling on the back of her left ankle for several years. Examination revealed a fusiform swelling of the Achilles' tendon. The serum cholesterol concentration was 352 mg per deciliter (9.1 mmol per liter), and triglyceride concentrations were normal. Physical examination revealed no other manifestations of a lipid disorder. Sagittal proton-weighted magnetic resonance imaging showed a homogeneously enlarged Achilles' tendon (arrow in Panel A) with increased signal intensity caused by xanthomatous material and parallel striation of low signal intensity caused by the collagen fibers of the tendon. Axial T₂-weighted magnetic resonance imaging revealed the characteristic diffuse, stippled pattern of a xanthoma (arrow in Panel B). A biopsy specimen showed xanthoma cells dispersed between the collagen fibers of the Achilles' tendon (arrow in Panel C) (hematoxylin and eosin, ×200).

Harrie C.M. van den Bosch, M.D.
Louwerens D. Vos, M.D.
Catharina Hospital, 5623 EJ Eindhoven, the Netherlands