Rectus Abdominis Rhabdomyolysis: Report of 2 Cases

Isolated rhabdomyolysis of long head of triceps mimicking upper extremity deep vein thrombosis

Rhabdomyolysis is characterised by skeletal muscle breakdown, with release of toxic intracellular contents into the circulation. A man in his 20s presented to the emergency department with acute-onset right arm swelling, with pitting oedema extending into his forearm without clear precipitant. Initial differential diagnosis was upper extremity deep vein thrombosis, however none was identified on CT venogram. Instead, rhabdomyolysis of long head of triceps was diagnosed after multidisciplinary review of the venogram by the treating vascular surgeon and radiologist. Retrospectively, added serum creatine kinase was found to be 11 587 U/L, and together with MRI of the right arm, the diagnosis was established. Given the patient's lack of comorbidities, normal renal function and reliability, he was managed conservatively as an outpatient without hospital admission for intravenous hydration. This is the only case to our knowledge of isolated long head of triceps' rhabdomyolysis reported in Australia and the second case worldwide.

Application of Ultrasonography in the Diagnosis of Rhabdomyolysis

Early diagnosis and treatment of rhabdomyolysis are very important, but difficult to achieve for some atypical cases. Our study was aimed at determining the diagnostic value of ultrasonography in rhabdomyolysis caused by different factors. The study enrolled 50 patients with rhabdomyolysis diagnosed in our hospital. Among the 50 cases (mean age = 38.4 y, 22 women) of rhabdomyolysis, 26 cases (mean age = 35.5 y, 8 women) were induced by exercise. During the patients' first visit, 5 cases (mean age = 30.6 y, 1 woman) were suspected of having rhabdomyolysis and were diagnosed by clinicians; 12 cases (mean age = 34.8 y, 5 women) were correctly diagnosed under ultrasound; and 9 cases (mean age = 39.2 y, 2 women) were misdiagnosed. Ultrasound did not play a critical role in 24 patients (mean age = 41.5 y, 14 women) with rhabdomyolysis caused by trauma, infection, crayfish consumption, drugs, alcohol and heat stroke. We then concluded that exercise-induced rhabdomyolysis is a common type of rhabdomyolysis. Ultrasonography plays an important role in the early diagnosis of exercise-induced rhabdomyolysis but has limited value in the diagnosis of rhabdomyolysis caused by other etiologies.