Medical Imaging Analysis Report

1. Imaging Findings

Based on the provided ultrasound images and the patient’s clinical information, the main findings are as follows:

• Marked diffuse thickening of the tendons around both knees, especially in the quadriceps tendon and patellar tendon regions, appearing fusiform in shape.
• Within the thickened tendons, the echo texture is relatively heterogeneous, and multiple hypoechoic or anechoic small nodules can be observed locally, showing “plaquelike” or “nodular” changes.
• Both Achilles tendons also present similar diffuse thickening and abnormal echoes.
• No obvious bone destruction or abnormal changes in the bone were found.

These findings suggest a possible infiltrative or depositional lesion involving the tendons or their insertion sites.

2. Potential Diagnoses

Based on the patient’s age, symptoms, and imaging characteristics, the following potential or differential diagnoses should be considered:

1. Tendon Xanthoma: Commonly associated with familial or secondary hyperlipidemia, presenting as lipid deposits in tendons and ligaments. On ultrasound, they appear as fusiform thickening with low or mixed echogenic nodular deposits.
2. Tendinopathy or enthesopathy (such as chronic tendonitis): Tendons may show thickening and heterogeneous echogenicity, but typically present with local pain or inflammatory changes and may not always have multiple nodular hypoechoic areas.
3. Lipoma or other soft tissue masses: Usually display relatively homogeneous fatty echogenicity on ultrasound, often with a well-defined border; less likely to present as multiple scattered nodules within the tendon.
4. Other infiltrative metabolic diseases: Such as gouty tophi. However, gouty lesions commonly appear in adults, often as hyperechoic foci or with calcifications, which do not match the findings in this case.

3. Final Diagnosis

Considering the patient’s age, clinical presentation (bilateral symmetrical tendon thickening and nodular changes), ultrasound features, and possible association with familial or secondary hyperlipidemia, the most likely diagnosis is:

Tendon Xanthomas

To further clarify the underlying cause, it is recommended to obtain a complete lipid profile (including TC, LDL-C, HDL-C, triglycerides, etc.) to assess for familial hyperlipidemia or other forms of secondary hyperlipidemia.

4. Treatment Plan and Rehabilitation Program

4.1 Treatment Strategy

• Lipid Management: If the patient is diagnosed with familial or other hyperlipidemia, lipid-lowering medications (e.g., statins) should be used under pediatric or endocrinology guidance, combined with dietary control and lifestyle modifications.
• Local Treatment: For tendon xanthomas without significant functional impairment or pain, conservative management and follow-up are generally preferred. If there is obvious pain, functional limitation, or a large mass affecting joint movement, surgical excision may be considered.
• Nutrition and Lifestyle: Follow a low-fat, balanced diet, avoid excessive sugar and saturated fats, and maintain a healthy body weight.

4.2 Rehabilitation and Exercise Prescription

In early or mild stages of the condition, a gradual, individualized rehabilitation strategy is recommended.

• Training Goals: Maintain joint range of motion, enhance tendon elasticity and strength, and reduce the risk of tendon injury.
• Exercise Methods:
  • Gentle range-of-motion exercises (active or passive stretching), such as straight leg raises and quadriceps strengthening exercises.
  • Low-impact aerobic activities, such as swimming or cycling, to minimize stress on the knee joints and Achilles tendons.
  • Progressive resistance exercises with low weight and higher repetitions, focusing on improving lower-limb muscle strength and endurance.
• FITT-VP Principle (Example):
  • Frequency: 3-4 sessions per week, with rest days as needed.
  • Intensity: Low to moderate intensity (RPE 3-4), gradually increasing according to the patient’s condition.
  • Time: 20-30 minutes per session, which can be divided into segments.
  • Type: Combined gentle joint mobility work, light resistance training, and aerobic activities.
  • Progression: Gradually increase exercise intensity and duration as the tendons adapt and symptoms improve.
• Precautions: If pain worsens or discomfort occurs, discontinue activity and seek medical evaluation. Patients with hyperlipidemia or cardiovascular concerns should exercise under professional guidance in a stepwise manner.

5. Disclaimer

This report is a reference analysis based on the current imaging and clinical information. It does not replace an in-person evaluation or a diagnosis and treatment plan made by a professional physician. Specific treatment and rehabilitation plans should be tailored to the patient’s actual condition and carried out under the guidance of a qualified medical professional.