Higuchi T, Yamamoto N, Nishida H, Hayashi K, Takeuchi A, Tsuchiya H. Treatment of infected calcific myonecrosis with chronically discharging sinus caused by iatrogenic aspiration: A case report.
Int J Surg Case Rep 2022;
95:107145. [PMID:
35561467 PMCID:
PMC9108875 DOI:
10.1016/j.ijscr.2022.107145]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/26/2022] [Accepted: 04/30/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction and importance
Calcific myonecrosis (CM) is a rare, benign post-traumatic sequela which is often challenging to differentiate from soft tissue tumors. Infected CM is recalcitrant and sometimes requires invasive treatment despite its benign nature. We present a case of infected CM in which MRI and 201Tl scintigraphy proved useful for diagnosis and intralesional debridement with prolonged placement of a suction tube allowed for successful treatment.
Case presentation
A 71-year-old man had undergone repeated aspiration for swelling of the lower leg and presented with a sustained pyogenic discharging wound. He underwent intralesional debridement of purulent necrotic tissue followed by prolonged suction tube placement. Enterobacter cloacae was detected in the discharge, and specific antibiotics were administered. Once the wound closed, a new sinus recurred four months after surgery, warranting reoperation with debridement of the remnant fascia and necrotic tissue with suction tube replacement. The wound healed eight months after the first surgery with no signs of recurrence.
Clinical discussion
CM can be diagnosed based on its unique imaging features and a history of compartment syndrome. To avoid infection, CM must be treated conservatively without surgical invasions, such as biopsy or aspiration. Extensive debridement with a myocutaneous flap is nevertheless recommended for infected CM treatment, despite significant invasion including intraoperative bleeding being problematic.
Conclusion
MRI and 201Tl scintigraphy can help diagnose CM and avoid biopsy to exclude malignancy. Intralesional debridement of necrotic tissue with prolonged suction tube placement could be a valid treatment alternative to reduce the invasiveness of infected CM.
Calcific myonecrosis is a rare, benign posttraumatic sequela.
Biopsy to differentiate malignancy can cause calcific myonecrosis.
Absence of accumulation on enhanced MRI or 201Tl scintigraphy helped diagnosis.
Extensive debridement and flaps are reliable but invasive in case of infection.
Intralesional debridement with prolonged tube placement may be less invasive.
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