1
|
Gonçalves DVC, da Silva LNM, Guimarães JB, da Cruz IAN, Filho AGO. Imaging spectrum of atraumatic muscle disorders: a radiologist's guide. Skeletal Radiol 2024; 53:1449-1464. [PMID: 38520541 DOI: 10.1007/s00256-024-04659-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
Atraumatic muscle disorders comprise a very wide range of skeletal muscle diseases, including metabolic, inflammatory, autoimmune, infectious, ischemic, and neoplastic involvement of the muscles. Therefore, one must take clinical and laboratory data into consideration to elucidate the differential diagnoses, as well as the distribution of the muscle compromise along the body-whether isolated or distributed along the body in a symmetric or asymmetrical fashion. Assessment of muscular disorders often requires imaging investigation before image-guided biopsy or more invasive procedures; therefore, radiologists should understand the advantages and limitations of imaging methods for proper lesion evaluation and be aware of the imaging features of such disorders, thus contributing to proper decision-making and good patient outcomes. In this review, we propose a systematic approach for the assessment of muscle disorders based on their main imaging presentation, dividing them into patterns that can be easily recognized.
Collapse
Affiliation(s)
| | - Lucas N M da Silva
- Department of Musculoskeletal Radiology, Fleury Medicina E Saúde, Sao Paulo, Brazil
| | | | - Isabela A N da Cruz
- Department of Musculoskeletal Radiology, Fleury Medicina E Saúde, Sao Paulo, Brazil
| | | |
Collapse
|
2
|
Shoukat HMH, Ajmal N. Diabetes-Associated Focal Myonecrosis: A Case Report and Literature Review. Cureus 2024; 16:e65323. [PMID: 39184753 PMCID: PMC11344616 DOI: 10.7759/cureus.65323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2024] [Indexed: 08/27/2024] Open
Abstract
Diabetes-associated focal myonecrosis is a rare complication seen in individuals with long-standing uncontrolled diabetes, characterized by inflammation and necrosis of a single or group of muscles. The exact cause of this condition is not well understood, but it is believed to be due to focal muscle infarction secondary to arteriosclerosis and diabetic microangiopathy. Diagnosis is challenging and often requires clinical examination, lab investigations, imaging, and EMG. Treatment is mainly supportive with pain control and tight glycemic control, and surgical intervention is rarely needed. The clinical presentation includes a sudden onset of localized pain and swelling in the affected muscle, which may be accompanied by fever, malaise, and weight loss. Diabetic myonecrosis exhibits a slightly higher prevalence in females and commonly manifests at an early stage. While the short-term prognosis is good, the recurrence rate is high, often affecting the opposite limb within six months. Our case describes a 35-year-old young male with uncontrolled diabetes mellitus, diagnosed one year ago, who presented with medial thigh pain and tenderness for the last two days. Due to his early disease, focal myonecrosis was not our first differential diagnosis. A CT scan with contrast revealed findings consistent with either focal myositis or infarction. We ruled out other causes, including infections, autoimmune disease, trauma, and medications, and in combination with the patient's uncontrolled diabetes mellites, a diagnosis of diabetes-associated focal myonecrosis was made. The patient improved with blood sugar control and supportive care, including nonsteroidal anti-inflammatory drugs and muscle relaxants.
Collapse
Affiliation(s)
| | - Namra Ajmal
- Pathology, Thomas Jefferson University Hospital, Philadelphia, USA
| |
Collapse
|
3
|
Shah DN, Chorya HP, Ramesh NN, Gnanasekaram S, Patel N, Sethi Y, Kaka N. Myopathies of endocrine origin: A review for physicians. Dis Mon 2024; 70:101628. [PMID: 37718136 DOI: 10.1016/j.disamonth.2023.101628] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Myopathies are a common manifestation of endocrine disorders. Endocrine myopathies are often overlooked while considering differential diagnoses in patients with musculoskeletal symptoms. The hindrance to mobility and the musculoskeletal discomfort owing to these myopathies are important causes of disability and depreciated quality of life in these patients. Endocrine myopathies occur due to the effects of endogenous or iatrogenic hormonal imbalance on skeletal muscle protein and glucose metabolism, disrupting the excitation-contraction coupling. Abnormalities of the pituitary, thyroid, parathyroid, adrenal, and gonadal hormones have all been associated with myopathies and musculoskeletal symptoms. Endocrine myopathies can either be the complication of a secondary endocrine disorder or a presenting symptom of a missed underlying disorder. Therefore, an underlying endocrine abnormality must always be excluded in all patients with musculoskeletal symptoms. This review presents a compilation of various endocrine myopathies, their etiopathogenesis, clinical presentation, diagnostic modalities, and treatment protocols.
Collapse
Affiliation(s)
- Devarsh N Shah
- Government Medical College Baroda, India; PearResearch, India
| | | | - N Nishitha Ramesh
- PearResearch, India; Father Muller Medical College, Mangalore, India
| | | | - Neil Patel
- PearResearch, India; GMERS Medical College, Himmatnagar, Gujarat, India
| | - Yashendra Sethi
- PearResearch, India; Government Doon Medical College, HNB Uttarakhand Medical Education University, Dehradun, Uttarakhand, India
| | - Nirja Kaka
- PearResearch, India; GMERS Medical College, Himmatnagar, Gujarat, India.
| |
Collapse
|
4
|
Ghantarchyan HH, Gupta S, Arabian S. An Abnormal Case of Diabetic Myonecrosis: A Case Report and Review of Literature. Cureus 2023; 15:e36050. [PMID: 37056556 PMCID: PMC10089644 DOI: 10.7759/cureus.36050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 03/14/2023] Open
Abstract
Diabetic myonecrosis, also known as diabetic muscle infarct, is a rare complication of diabetes mellitus, generally associated with poor glycemic control. It is often difficult to diagnose due to its nonspecific presentation and lack of awareness of the complication. Routine laboratory investigations often do not aid in diagnosis. Magnetic resonance imaging (MRI) may assist in diagnosis but is not routinely ordered due to cost-effectiveness and nonspecific radiologic appearance. Muscle biopsy can provide a definite diagnosis; however, it is often avoided due to its invasiveness. Treatment consists of glycemic control, rest, and analgesics for pain control. Our case describes a 42-year-old male with uncontrolled diabetes who presented with four weeks of progressively worsening right-sided lower extremity pain. The patient was taken to the operating room for concern for necrotizing fasciitis; however, it was ultimately ruled out. A diagnosis of diabetic myonecrosis was made. Recommendations were given for strict blood sugar control and to start aspirin 81 mg daily. The patient was later seen in the outpatient clinic with improvement in the lower extremity pain.
Collapse
|
5
|
Ramachandran V. Myonecrosis complicating uncontrolled diabetes mellitus. Proc AMIA Symp 2022; 35:693-694. [DOI: 10.1080/08998280.2022.2086787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Vignesh Ramachandran
- Department of Dermatology, New York University, New York, New York
- Department of Internal Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
| |
Collapse
|
6
|
Sim J, Ting Y, Low E. Tabetic arthropathy of the knee, complicated by lower limb myonecrosis. BMJ Case Rep 2021; 14:14/7/e242753. [PMID: 34281942 DOI: 10.1136/bcr-2021-242753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jordan Sim
- Tan Tock Seng Hospital, National Healthcare Group, Singapore .,Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Yonghan Ting
- Tan Tock Seng Hospital, National Healthcare Group, Singapore.,Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Eugene Low
- Tan Tock Seng Hospital, National Healthcare Group, Singapore.,Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| |
Collapse
|
7
|
Patibandla S, Auron M, Olson AP, Chamberlain S, Pendharkar SS. A Painful Coincidence? J Hosp Med 2021; 16:371-375. [PMID: 34129490 DOI: 10.12788/jhm.3514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 08/04/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Saikrishna Patibandla
- Department of Medicine, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, New York
| | - Moises Auron
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Andrew Pj Olson
- Departments of Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Samantha Chamberlain
- Department of Emergency Medicine, Ascension St John's Hospital, Detroit, Michigan
| | - Sima S Pendharkar
- Department of Medicine, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, New York
| |
Collapse
|
8
|
Jalali Z, Sharif SK. Upper-Limb Diabetic Myonecrosis: Atypical Presentation of a Rare Complication. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1268-1272. [PMID: 31455756 PMCID: PMC6753662 DOI: 10.12659/ajcr.917030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Myonecrosis is an uncommon complication of poorly controlled diabetes, predominantly involving the lower limbs. It is an atypical presentation in the upper limbs. Here, we report a rare case with atypical involvement of the upper limbs. CASE REPORT A 53-year-old diabetic woman presented with left arm pain for the past week. She was not compliant with her medications. The patient denied any history of trauma or injection. Physical examination revealed a warm, tender, and erythematous swelling on the medial side of the left arm and was otherwise unremarkable. Her glycemic control was poor, with Hb A1C of 9.6%. Duplex ultrasonography demonstrated no evidence of fluid collection or thrombosis. An initial MRI (without contrast) report was misleadingly suggestive of polymyositis. Orthopedic consultant urged the patient to transfer to the operating room for aspiration of a probable infectious nidus, which resulted in a dry tap. Despite confusing radiological clues, ischemic myonecrosis was suspected, and second MRI studies (with contrast) reported necrosis. Tissue biopsy (the criterion standard) was withheld to avoid the risk of delayed healing or superimposed infection. Meanwhile, the patient received supportive treatment and achieved full recovery within 1 month. CONCLUSIONS Diabetic myonecrosis should be suspected in any poorly controlled diabetic patient presenting with otherwise unexplained muscle pain without any evidence of infection. Diagnosis can be made by MRI, leaving very few indications for invasive procedures. Analgesics and glycemic control are the mainstays of treatment.
Collapse
Affiliation(s)
- Zahra Jalali
- Faculty of Medicine, Tabriz University of Medical Sciences, Imam Reza Hospital, Tabriz, Iran
| | - Sakineh Khatoun Sharif
- Rheumatology Research Center, Tabriz University for Medical Sciences, Tabriz, Iran.,Department of Rheumatology, Iranian Rheumatology Association, Tehran, Iran
| |
Collapse
|