Medical Analysis Report

I. Radiological Findings

A soft tissue mass is visible in the medial malleolus area of the patient’s right ankle. Ultrasound shows relatively well-defined margins, uniformly low echo, and visible blood flow signals, presenting an elliptical or round shape with a rich local blood supply.
MRI (T1-weighted images) reveals that the lesion appears isointense or slightly hypointense with relatively clear margins. After contrast injection, enhancement of the lesion is observed. On T2-weighted images, the center of the mass exhibits relatively low signal, whereas the periphery shows higher signal, forming a “target sign.” The surrounding fat layer presents a “split-fat sign.” In transverse sections, the lesion may display a “fascicular sign,” indicative of a nerve sheath-related lesion.

II. Potential Diagnoses

1. Schwannoma: This tumor commonly originates from peripheral Schwann cells. In imaging, it frequently appears as a well-defined soft tissue mass showing high signal on T2-weighted images and can exhibit characteristic target and fascicular signs, which aligns with the findings in this case.
2. Neurofibroma: Another benign tumor arising from the nerve sheath, with imaging features similar to schwannomas. However, it often involves the nerve trunk itself and can be associated with other cutaneous nerve segments.
3. Ganglion cyst or synovial cyst: Common in the ankle region, typically appearing as anechoic or hypoechoic cystic lesions on ultrasound with clear margins, but lacking notable blood flow signals and the specific nerve sheath indications described above.
4. Other soft tissue tumors: Such as lipoma or fibroma. However, based on the imaging features observed here, they are less likely, especially given the lesion’s association with a local nerve structure.

Considering the patient’s imaging features and medical history, a neurogenic tumor is highly suspected. Among these, a schwannoma (Schwannoma) is the most likely diagnosis.

III. Final Diagnosis

Based on postoperative pathology and imaging findings, in conjunction with the patient’s clinical symptoms and physical examination, the most likely final diagnosis is Schwannoma. This tumor is typically benign, arising from Schwann cells, and commonly affects large- or medium-sized nerves in the limbs.

If there are indications suggesting malignancy or atypical pathological findings, further surgical resection and pathological examination may be necessary to confirm the lesion’s nature.

IV. Treatment Plan and Rehabilitation

1. Treatment Strategy:
For benign schwannomas, treatment can be decided based on clinical symptom severity and patient preference, ranging from surgical resection to conservative observation:

• For smaller lesions but with significant symptoms or those located in high-risk nerves, surgical resection is often advised to relieve pressure and prevent further nerve damage.
• If the lesion is small and symptoms are mild, follow-up imaging may suffice. If the lesion exhibits no significant growth, conservative monitoring may be continued.
• For patients experiencing pain or neuropathy-like symptoms, nerve nutrition and analgesic medications (e.g., B vitamins, gabapentin) may help alleviate discomfort.

2. Rehabilitation and Exercise Prescription:
Post-surgery or during conservative treatment, the rehabilitation plan should be guided by the patient’s joint mobility, muscle strength, and pain level. Emphasis is placed on protecting the surgical site or pain area while progressively enhancing ankle function and strengthening surrounding muscles. Key steps include:

• Acute Rehabilitation Phase (Postoperative weeks 1–2 or initial symptom phase): Focus on protection and pain reduction, avoiding excessive weight-bearing. Gentle passive or mild active ankle movements can be performed to prevent joint stiffness.
• Functional Recovery Phase (Typically 2–6 weeks post-surgery): Gradually increase active ankle movements, such as ankle pumping exercises, foot stretches, and low-impact activities like stationary cycling, aiming to improve circulation and build muscle strength.
• Strengthening Phase (Around 6 weeks post-surgery): Slowly progress to moderate resistance training, for example using resistance bands for ankle exercises, Achilles tendon stretching, and balance training (such as single-leg stance), helping to improve ankle stability.
• Exercise Progression (FITT-VP Principle): Gradually enhance frequency and intensity (Frequency, Intensity, Time, Type, Volume, Progression) according to the patient’s fitness and rehabilitation progress. Start with low-intensity, high-frequency, and short-duration activities, then incrementally add weight-bearing, extend exercise duration, and increase intensity.
• Individualization Principle: Patients with osteoporosis, suboptimal cardiopulmonary function, or other comorbidities should work with a rehabilitation specialist or physician to develop a personalized plan and be closely monitored for safety.

Proper and moderate rehabilitation can help restore ankle function, reduce pain, and prevent secondary injury. If significant swelling, severe pain, or worsening neurological symptoms occur during exercise, seek medical evaluation promptly.

Disclaimer: This analysis report provides a reference opinion based on existing patient history and imaging data. It is not a substitute for in-person consultation or professional medical advice. Should any concerns arise or the condition change, please seek immediate medical attention.