Diabetic myonecrosis

Last revised by JAVIER DIEZ GARCIA on 5 Aug 2021

Diabetic myonecrosis is an uncommon complication of diabetes mellitus, occurring in patients with chronic poor glycemic control. 

There is a slight predilection for females and patients with type 1 diabetes. The average age of presentation is 40 years. 

Patients present with acute onset of pain, tenderness, and swelling, more often in the lower limbs, with the thigh being the most common site. 

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. 

Diabetic myonecrosis most commonly affects the lower limbs 7:

  • diffuse muscle enlargement with decreased attenuation
  • hyperattenuating subcutaneous fat 2

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

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

Diabetic myonecrosis was first described by Angervall and Stener in 1965. 

On imaging, possible differential considerations include:

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Cases and figures

  • Case 1
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  • Case 2: ultrasound
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  • Case 2: MRI
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