1
|
Expansile calcific myonecrosis arising in the lower leg: A case report and recommendation for treatment. J Orthop Sci 2022; 27:1149-1153. [PMID: 31870641 DOI: 10.1016/j.jos.2019.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/23/2019] [Accepted: 11/28/2019] [Indexed: 11/23/2022]
|
2
|
Angelini A, Mavrogenis AF, Pagliarini E, Trovarelli G, Fanelli GN, Cappellesso R, Ruggieri P. Calcific Myonecrosis of the Leg: A Rare Entity. ACTA ACUST UNITED AC 2019; 55:medicina55090542. [PMID: 31466356 PMCID: PMC6780786 DOI: 10.3390/medicina55090542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/20/2019] [Accepted: 08/23/2019] [Indexed: 11/20/2022]
Abstract
Calcific myonecrosis is a rare disease that has been shown to be a late sequela of trauma. This article presents a 68-year-old man with calcific myonecrosis of the leg 40 years after a tibial fracture complicated with peroneal nerve palsy. The soft tissue mass increased in size after another injury to the leg that occurred two years before his presentation. Physical examination at presentation showed a palpable extra-osseous mass at the anterior aspect of the left leg; the mass was not adherent to adjacent soft-tissues and bone, and it was painless but tender to palpation. Radiographs of the left leg showed extensive calcification at the soft-tissue of the anterior and posterior leg. An ultrasonography-guided trocar biopsy was done; histological findings were indicative of calcific myonecrosis. Given the benign entity of the lesion and known high rate of complications, he was recommended for no further treatment except for clinical and imaging observation. Located at the site of the biopsy, he experienced infection with drainage that eventually healed after six months with antibiotics and wound dressing changes. During the last follow-up examination, two years after diagnosis, the patient was asymptomatic without progression of the mass.
Collapse
Affiliation(s)
- Andrea Angelini
- Department of Orthopaedics and Orthopaedic Oncology, University of Padova, 35128 Padova, Italy
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 115 27 Athens, Greece
| | - Elisa Pagliarini
- Department of Orthopaedics and Orthopaedic Oncology, University of Padova, 35128 Padova, Italy
| | - Giulia Trovarelli
- Department of Orthopaedics and Orthopaedic Oncology, University of Padova, 35128 Padova, Italy
| | - Giuseppe Nicolò Fanelli
- Department of Medicine, Surgical Pathology & Cytopathology Unit, University of Padova, 35128 Padova, Italy
| | - Rocco Cappellesso
- Department of Medicine, Surgical Pathology & Cytopathology Unit, University of Padova, 35128 Padova, Italy
| | - Pietro Ruggieri
- Department of Orthopaedics and Orthopaedic Oncology, University of Padova, 35128 Padova, Italy.
| |
Collapse
|
3
|
Ukon Y, Tanaka T, Nagata S, Hagizawa H, Imura Y, Tamiya H, Oshima K, Naka N, Aoki Y, Kuratsu S. Calcific myonecrosis mimicking soft tissue sarcoma: A case report. Oncol Lett 2018; 15:7909-7913. [PMID: 29731908 PMCID: PMC5920900 DOI: 10.3892/ol.2018.8320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 02/28/2018] [Indexed: 12/26/2022] Open
Abstract
Calcific myonecrosis is a rare soft tissue condition. The first case was reported in 1960, however, the precise pathophysiology of calcific myonecrosis remains unclear. The disease was thought to arise from compartment syndrome within a confined space resulting in necrosis and fibrosis, subsequent repeated intralesional hemorrhage, mass enlargement and calcification. Several previous reports have described calcific myonecrosis, which include the formation of calcific myonecrosis after a prolonged period of post trauma. Notably, calcific myonecrosis has typically been described in the lower legs and characteristic imaging findings have been indicated. Furthermore, surgical intervention carries a high risk of complications. In the present case report 2 cases of calcific myonecrosis that occurred after a prolonged period of time following a traumatic event that impacted the lower leg were reported. CT images revealed disruption of calcified fascia and disease expansion into the outside of the fascia. Previous reports have implied that there is late focal enlargement of calcific myonecrosis following earlier enlargement, which may be caused by herniation through muscle fascia. However, no previous publications have focused on images for evidence of late local enlargement. To the best of our knowledge, this is the first report focusing on fascial herniation of calcific myonecrosis using images. Analysis of this feature using images may aid clinicians to differentiate calcific myonecrosis from malignancies.
Collapse
Affiliation(s)
- Yuichiro Ukon
- Department of Orthopaedic Surgery, Belland General Hospital, Sakai, Osaka 599-8247, Japan.,Department of Orthopaedic Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Takaaki Tanaka
- Department of Orthopaedic Surgery, Belland General Hospital, Sakai, Osaka 599-8247, Japan.,Department of Orthopaedic Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Shigenori Nagata
- Department of Pathology and Cytology, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Hiroki Hagizawa
- Department of Orthopaedic Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Yoshinori Imura
- Department of Orthopaedic Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Hironari Tamiya
- Department of Orthopaedic Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Kazuya Oshima
- Department of Orthopaedic Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Norifumi Naka
- Department of Orthopaedic Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Yasuaki Aoki
- Department of Orthopaedic Surgery, Japanese Red Cross Society Himeji Hospital, Himeji, Hyogo 670-8540, Japan
| | - Shigeyuki Kuratsu
- Department of Orthopaedic Surgery, Belland General Hospital, Sakai, Osaka 599-8247, Japan
| |
Collapse
|
4
|
Nagamoto H, Hosaka M, Watanuki M, Shiota Y, Hatori M, Watanabe M, Hitachi S, Itoi E. Calcific myonecrosis arising in the bilateral deltoid muscles: A case report. J Orthop Sci 2017; 22:790-794. [PMID: 26806333 DOI: 10.1016/j.jos.2015.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 11/10/2015] [Accepted: 12/09/2015] [Indexed: 02/09/2023]
Affiliation(s)
- Hideaki Nagamoto
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masami Hosaka
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Munenori Watanuki
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuki Shiota
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masahito Hatori
- Department of Orthopaedic Surgery, Tohoku Kosai Hospital, Sendai, Japan
| | - Mika Watanabe
- Department of Pathology, Tohoku University Hospital, Sendai, Japan
| | - Shin Hitachi
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| |
Collapse
|
5
|
Yuenyongviwat V, Laohawiriyakamol T, Suwanno P, Kanjanapradit K, Tanutit P. Calcific myonecrosis following snake bite: a case report and review of the literature. J Med Case Rep 2014; 8:193. [PMID: 24934373 PMCID: PMC4086687 DOI: 10.1186/1752-1947-8-193] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 04/01/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction Calcific myonecrosis is a rare condition in which muscle in a limb compartment undergoes necrosis and becomes peripherally calcified with central liquefaction. The patient usually presents with a slowly progressive enlarged mass that sometimes can be misdiagnosed as soft tissue sarcoma. Most of the reported cases showed that the disease occurs often after trauma or compartment syndrome. However, the case of calcific myonecrosis following snake bite is rarely reported. Case presentation A 66-year-old Thai woman presented with a gradually progressive enlarged mass over a period of 10 years in her left leg. She had a history of untreated compartment syndrome after she was bitten by a snake (Malayan pit viper) in her left leg when she was 14-years old. At presentation, a plain X-ray showed a large soft tissue mass at the anterior compartment of her left leg. A sheet-like mass with an enlarged central cavity combined with peripheral calcification and cortical erosion of her tibia were observed. A biopsy was performed and the result was negative for neoplastic cells. During a 5-year follow-up, the mass progressively enlarged and then became infected and finally broke through the skin. She was treated by excision of the mass and administration of antibiotics. The wound completed healed at 1 month postsurgery. There was no wound complication or disease recurrence at 1 year postoperation. Conclusions The diagnosis of calcific myonecrosis was done by history taking and radiographic interpretation. In an asymptomatic patient the management should be observation and clinical follow-up. A biopsy should be avoided due to the high rate of postoperative infection. Treatment of choice in a symptomatic condition is mass excision.
Collapse
Affiliation(s)
- Varah Yuenyongviwat
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand.
| | | | | | | | | |
Collapse
|