Diabetic myonecrosis is an uncommon complication of diabetes mellitus, occurring in patients with chronic poor glycemic control.
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Epidemiology
There is a slight predilection for females and patients with type 1 diabetes. The average age of presentation is 40 years.
Clinical presentation
Patients present with acute onset of pain, tenderness, and swelling, more often in the lower limbs, with the thigh being the most common site.
Pathology
The exact cause is unknown but diabetic myonecrosis is a skeletal muscle injury thought to be from atherosclerotic occlusion, hypoxia-reperfusion or vasculitis with thrombus.
Location
Diabetic myonecrosis most commonly affects the lower limbs 7:
- quadriceps (~60%)
- hip adductors (~15%)
- hamstrings (~10%)
- hip flexors (~2%)
Radiographic features
CT
- diffuse muscle enlargement with decreased attenuation
- hyperattenuating subcutaneous fat 2
MRI
MRI findings are non-specific, but a mass-like area of muscle necrosis is noted along with diffuse fascial and subcutaneous soft-tissue edema 1,2,5,6:
- T1: iso- to hypointense
- T2 Fat-Sat: enlarged muscle(s) with diffuse high signal
- C+ (Gd): heterogeneous/peripheral enhancement
Treatment and prognosis
Normally responds well to conservative treatment and is self-limiting. High (>50%) recurrence rates are reported 2,3. Prognosis is poor with most patients dying within five years 4.
History and etymology
Diabetic myonecrosis was first described by Angervall and Stener in 1965.
Differential diagnosis
On imaging, possible differential considerations include:
- infection, e.g. infectious myositis, necrotizing fasciitis, abscess, cellulitis
- acute compartment syndrome
- malignancy
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