Missed Achilles rupture
Hey all, educational question :)
I'm a last year resident and, in my last shift, I had the patient with a painful calf at the level of Achilles after he mistakenly stepped during the walk. Few years ago, he had an Achilles rupture on the other leg and, comparing both, he said this injury was far less serious for him compared to the previous. Clinically, he had no hematoma, no palpable gap, Thompson was negative (i squeezed his calf like 5 times to be sure). He was barely limping. We do not usually spam ultrasounds for every suspicious tendon rupture at the hospital but I usually do them on my own just for the sake of educating myself. This time, having a busier ER than usual, I decided to skip it as it seemed to me unlikely that he had a rupture based on his history and physical exam.
Today, I found out he went to another hospital 12 hours lated and was diagnosed with the ruptured Achilles and positive Thompson. Now, I do not know if he had another injury in the meantime but I do not think so. Have you ever experienced that? Do you proceed with the imaging regardless of history and physical exam in these situations or you rely on clinical exam more? I know other calf muscles can compensate for the ruptured Achilles and have observed some of those but they were still looking far worse than this patient was.
Thanks all,
EDIT : I wrote he had a surgery first but it was misinformation from my department. I called my colleague who’s working at that hospital and it was a high rupture that will be treated conservatively. Still, I missed it.