Ultrasonographic diagnosis of intraneural hemorrhage of the sciatic nerve

This case shows how ultrasound helped diagnose a rare intraneural hemorrhage of the sciatic nerve in a patient with calf atrophy after heavy jogging while using antiplatelet therapy. Ultrasound identified both denervation changes in the gastrocnemius and an anechoic intraneural collection within the sciatic nerve near its bifurcation. Its main clinical value was that it provided a real-time morphologic diagnosis that explained the neuropathy more directly than electrodiagnostic testing alone.

Interesting highlights:

• Ultrasound detected muscle denervation atrophy as decreased thickness and increased echogenicity of the medial gastrocnemius.

• Dynamic imaging showed an intraneural fluid collection splitting the sciatic nerve longitudinally near the popliteal fossa.

• Sono-Tinel was positive, supporting the symptomatic nerve level.

• Surgery later confirmed fibrous thickening from previous hemorrhage, supporting the ultrasound diagnosis.

Who is this article most useful for?
MSK ultrasound clinicians, peripheral nerve specialists, PM&R physicians, neurologists, and radiologists evaluating unexplained calf atrophy or unusual neuropathies.