Schwannoma of the Posterior Tibial Nerve: An Unusual Finding during Arterial Ultrasound Examination of the Lower Extremities

Abstract

Introduction

Ultrasound examination of the lower extremity, regardless of the motive, can yield a considerable amount of data essential to the diagnosis of various diseases.

Case Report

We reported a clinical case of a woman, 50 years of age, who was sent to our vascular laboratory for arterial ultrasound examination of the lower extremities. She complained of coldness of the left foot associated with paresthesia and hypersensitivity of the middle third of the left lower leg for the past 3 years. During physical examination, there was a diminished, but palpable, posterior tibial artery pulse. The ultrasound performed revealed a tumor of the posterior tibial nerve, with 4 cm in longitudinal dimension and 2.7 cm of maximum diameter, typical of a neurofibroma or a schwannoma, with anterior deviation of the vascular structures. She was referred to a plastic surgeon and submitted to surgical resection of the nerve sheath tumor, with preservation of artery and venous flow. Histological analysis revealed a capsulated mass with fusiform cells, without atypical cells, compatible with a schwannoma. Patient completed 1 year of follow-up, maintaining a slight, nondisabling, local hypersensitivity.

Discussion

This clinical case shows an interesting imaging finding, with major repercussions in the treatment of this patient.