JBJS | Idiopathic Necrosis of Skeletal Muscle in Patients Who Have Diabetes. Report of Four Cases and Review of the Literature*

The Journal of Bone & Joint Surgery, Volume 80, Issue 2

Articles | February 01, 1998

Idiopathic Necrosis of Skeletal Muscle in Patients Who Have Diabetes. Report of Four Cases and Review of the Literature*

TIMOTHY A. DAMRON, M.D.†; E. MARK LEVINSOHN, M.D.‡; THOMAS M. MCQUAIL, M.D.†; HAL COHEN, M.D.†; MICHAEL STADNICK, M.D.†; MICHELE ROONEY, M.D.†, SYRACUSE, NEW YORK

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Investigation performed at the Departments of Orthopedic Surgery, Radiology, and Pathology, State University of New York at Syracuse, and the Department of Radiology, Crouse Hospital, Syracuse

The Journal of Bone & Joint Surgery. 1998; 80:262-7

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Case Reports

Case Reports | Discussion | Introduction | References

Discussion

Case Reports | Discussion | Introduction | References

Introduction

Case Reports | Discussion | Introduction | References

*No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.

†Departments of Orthopedic Surgery (T. A. D. and T. M. McQ.), Radiology (H. C. and M. S.), and Pathology (M. R.), State University of New York at Syracuse, 550 Harrison Center, Syracuse, New York 13202. E-mail address for Dr. Damron: damront@vax.cs.hscsyr.edu.

‡Crouse Hospital, 736 Irving Avenue, Syracuse, New York 13210.

*No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.

‡Crouse Hospital, 736 Irving Avenue, Syracuse, New York 13210.

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Figs. 1-A through 1-D: Case 1. Fig. 1-A: T1-weighted axial magnetic resonance image made through the middle third of both thighs after the intravenous administration of gadolinium. There is increased signal intensity within the right vastus medialis muscle (Vm) and part of the vastus lateralis muscle, with diffuse swelling of the vastus medialis muscle and of the overlying subcutaneous fat. The remaining muscles and the neurovascular structures are normal. There is a small region of intermediate signal intensity (arrow) medially, which was found at the time of the biopsy to be an intramuscular collection of fluid. The cortical bone and the marrow space appear normal. The left thigh is normal.

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Fig. 1-B T2-weighted axial magnetic resonance image, made through the middle portion of the right thigh, showing increased signal intensity within the entire vastus medialis muscle (Vm); this finding was indicative of generalized edema. Areas of increased signal intensity also are seen in the vastus lateralis muscle. The thigh is otherwise normal.

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Fig. 1-C Proton-density-weighted coronal magnetic resonance image, made through both thighs, showing generalized swelling with diffusely increased signal intensity in the right vastus medialis muscle (Vm). The cortical bone and the marrow appear normal. The left thigh is normal. F = femur. (Reprinted, with permission, from: Damron, T. A., and Sim, F. H.: Soft-tissue tumors about the knee. J. Am. Acad. Orthop. Surg., 5: 146, 1997.)

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Fig. 1-D Photomicrograph revealing acute necrosis of skeletal muscle and associated soft tissues. The arrows indicate degenerating muscle fibers (hematoxylin and eosin, x100).

References

Case Reports | Discussion | Introduction | References

Angervall, L.,Stener, B. Tumoriform focal muscular degeneration in two diabetic patients. Diabetologia,1: 39-42. 1965;139 1965

Banker, B. Q.,Chester, C. S. Infarction of thigh muscle in the diabetic patient. Neurology,23: 667-677. 1973;23667 1973 [PubMed]

Barohn, R. J.,Kissel, J. T. Case-of-the-month: painful thigh mass in a young woman: diabetic muscle infarction. Muscle and Nerve,15: 850-855. 1992;15850 1992 [PubMed]

Barton, K. L.,Palmer, B. F. Bilateral infarction of the vastus lateralis muscle in a diabetic patient: a case report and review of the literature. J. Diabetes and Complicat.,7: 221-223. 1993;7221 1993

Boluda, B., Mesa, J., Obiols, G.,Simo, R. Focal muscle infarction in a diabetic. Diabete Metabol.,15: 269-270. 1989;15269 1989

Chason, D. P., Fleckenstein, J. L., Burns, D. K.,Rojas, G. Diabetic muscle infarction: radiologic evaluation. Skel. Radiol.,25: 127-132. 1996;25127 1996

Chester, C. S.,Banker, B. Q. Focal infarction of muscle in diabetics. Diabetes Care,9: 623-630. 1986;9623 1986 [PubMed]

Hinton, A., Heinrich, S. D.,Craver, R. Idiopathic diabetic muscular infarction: the role of ultrasound, CT, MRI, and biopsy. Orthopedics,16: 623-625. 1993;16623 1993 [PubMed]

Lauro, G. R., Kissel, J. T.,Simon, S. R. Idiopathic muscular infarction in a diabetic patient. Report of a case. J. Bone and Joint Surg.,73-A: 301-304. Feb. 1991;73-A301 1991

Levinsohn, E. M.,Bryan, P. J. Computed tomography in unilateral extremity swelling of unusual cause. J. Comput. Assist. Tomog.,3: 67-70. 1979;367 1979

Mirra, J. M. Letter to the editor. Clin. Orthop.,327: 308-310. 1996;327308 1996 [PubMed]

Nunez-Hoyo, M., Gardner, C. L., Motta, A. O.,Ashmead, J. W. Skeletal muscle infarction in diabetes: MR findings. J. Comput. Assist. Tomog.,18: 986-988. 1993;18986 1993

Ratliff, J. L., Matthews, J., Blalock, J. C.,Kasin, J. V. Infarction of the quadriceps muscle: a complication of diabetic vasculopathy. Southern Med. J.,79: 1595. 1986;791595 1986 [PubMed]

Reich, S., Wiener, S. N., Chester, S.,Ruff, R. Clinical and radiologic features of spontaneous muscle infarction in the diabetic. Clin. Nucl. Med.,10: 876-879. 1985;10876 1985 [PubMed]

Rocca, P. V., Alloway, J. A.,Nashel, D. J. Diabetic muscular infarction. Sem. Arthrit. and Rheumat.,22: 280-287. 1993;22280 1993

Vande Berg, B., Malghem, J., Putteman, T., Vandeleene, B., Lagneau, G.,Meldague, B. Idiopathic muscular infarction in a diabetic patient. Skel. Radiol.,25: 183-185. 1996;25183 1996

Van Slyke, M. A.,Ostrov, B. E. MRI evaluation of diabetic muscle infarction. Magnet. Reson. Imag.,13: 325-329. 1995;13325 1995

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