Emergency Radiology

, Volume 26, Issue 3, pp 349–359 | Cite as

Sonographic assessment of musculoskeletal causes of calf pain and swelling

  • Kheng Song LeowEmail author
  • Kian Ming Chew
  • Ashish Chawla
  • Tze Chwan Lim
Pictorial Essay


Calf pain or swelling is a common presentation to the emergency department. The differential diagnoses are wide. Deep vein thrombosis (DVT) is often the first diagnosis to be excluded given its potentially fatal complications. Musculoskeletal causes of calf pain or swelling such as Baker’s cyst, muscle or tendon tear, soft tissue infection, and inflammation are not uncommon and can often be confidently diagnosed with ultrasonography (US). Familiarity with these conditions and the sonographic findings would be useful in making timely and correct diagnosis.


Achilles tendon Baker’s cyst Cellulitis Myositis Ultrasonography 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Chawla A, Dubey N, Chew KM, Singh D, Gaikwad V, Peh WCG (2017) Magnetic resonance imaging of painful swollen legs in the emergency department: a pictorial essay. Emerg Radiol 24(5):577–584. CrossRefGoogle Scholar
  2. 2.
    Janzen DL, Peterfy CG, Forbes JR, Tirman PF, Genant HK (1994) Cystic lesions around the knee joint: MR imaging findings. Am J Roentgenol 163(1):155–161. CrossRefGoogle Scholar
  3. 3.
    Ward EE, Jacobson JA, Fessell DP, Hayes CW, van Holsbeeck M (2001) Sonographic detection of Baker’s cysts: comparison with MR imaging. Am J Roentgenol 176:373–380. CrossRefGoogle Scholar
  4. 4.
    Miller TT, Staron RB, Koenigsberg T, Levin TL, Feldman F (1996) MR imaging of Baker cysts: association with internal derangement, effusion, and degenerative arthropathy. Radiology 201(1):247–250. CrossRefGoogle Scholar
  5. 5.
    Shah J, Shah B, Shah A (2010) Pictorial essay: ultrasonography in ‘tennis leg’. Indian J Radiol Imaging 20(4):269–273. CrossRefGoogle Scholar
  6. 6.
    Gilbert TJ, Bullis BR, Griffiths HJ (1996) Tennis calf or tennis leg. Orthopedics 19(2):179, 182, 184. doi: not availableGoogle Scholar
  7. 7.
    Delgado GJ, Chung CB, Lektrakul N, Azocar P, Botte MJ, Coria D, Bosch E, Resnick D (2002) Tennis leg: clinical US study of 141 patients and anatomic investigation of four cadavers with MR imaging and US. Radiology 223(1):112–119. CrossRefGoogle Scholar
  8. 8.
    Lee JC, Healy J (2004) Sonography of lower limb muscle injury. Am J Roentgenol 182(2):341–351. CrossRefGoogle Scholar
  9. 9.
    Adhikari S, Blaivas M (2012) Sonography first for subcutaneous abscess and cellulitis evaluation. J Ultrasound Med 31(10):1509–1512. CrossRefGoogle Scholar
  10. 10.
    Cardinal E, Bureau NJ, Aubin B, Chhem RK (2001) Role of ultrasound in musculoskeletal infections. Radiol Clin N Am 39(2):191–201. CrossRefGoogle Scholar
  11. 11.
    Canoso JJ, Barza M (1993) Soft tissue infections. Rheum Dis Clin N Am 19(2):293–309Google Scholar
  12. 12.
    Chauhan S (2004) Tropical pyomyositis (myositis tropicans): current perspective. Postgrad Med J 80(943):267–270. CrossRefGoogle Scholar
  13. 13.
    Chau CLF, Griffith JF (2005) Musculoskeletal infections: ultrasound appearances. Clin Radiol 60(2):149–159. CrossRefGoogle Scholar
  14. 14.
    O’Brien M (2005) The anatomy of the Achilles tendon. Foot Ankle Clin 10(2):225–238. CrossRefGoogle Scholar
  15. 15.
    Jamadar DA, Jacobson JA, Theisen SE, Marcantonio DR, Fessell DP, Patel SV, Hayes CW (2002) Sonography of the painful calf: differential considerations. Am J Roentgenol 179(3):709–716. CrossRefGoogle Scholar
  16. 16.
    Babaei-Ghazani A, Ebadi S, Forogh B (2016) Sonographic diagnosis of acute Achilles tendon tear: a case report 1(1):1002. doi: not availableGoogle Scholar
  17. 17.
    Mohammadi A, Ghasemi-Rad M, Khodabakhsh M (2011) Non-opaque soft tissue foreign body: sonographic findings. BMC Med Imaging 11:9. CrossRefGoogle Scholar
  18. 18.
    Donaldson JS (1991) Radiographic imaging of foreign bodies in the hand. Hand Clin 7(1):125–134Google Scholar
  19. 19.
    Beggs I (2003) Sonography of muscle hernias. Am J Roentgenol 180(2):395–399. CrossRefGoogle Scholar
  20. 20.
    Bianchi S, Abdelwahab IF, Mazzola CG, Ricci G, Damiani S (1995) Sonographic examination of muscle herniation. J Ultrasound Med 14(5):357–360. CrossRefGoogle Scholar

Copyright information

© American Society of Emergency Radiology 2019

Authors and Affiliations

  • Kheng Song Leow
    • 1
    Email author
  • Kian Ming Chew
    • 2
  • Ashish Chawla
    • 1
  • Tze Chwan Lim
    • 2
  1. 1.Department of Diagnostic RadiologyKhoo Teck Puat HospitalSingaporeRepublic of Singapore
  2. 2.Department of Diagnostic RadiologyWoodlands Health CampusSingaporeRepublic of Singapore

Personalised recommendations