Last revised by Daniel J Bell on 20 Apr 2021

Rhabdomyolysis describes the breakdown of striated muscles with the release of intracellular contents and represents a severe muscle injury. MRI is the imaging modality of choice. Rhabdomyolysis is potentially life-threatening although recovery is excellent with early treatment.

Symptoms and signs are varied, but a classic triad of muscle pain, weakness, and dark urine are described. 

Most common causes reported in Western adult populations are trauma/crush injury, exercise, cocaine and immobilization. The range of causes is wide: 

Rhabdomyolysis has a heterogeneously hypodense appearance on CT. There may be rim-enhancement on post-contrast images 7,8.

Edema throughout affected muscles with signal intensity reflecting the severity of an injury is seen in mild-moderate cases. When severe, features of myonecrosis will be demonstrated. Two types of MRI findings have been described 4,8:

  • type 1
    • T1: homogeneously iso to hyperintense
    • T2/STIR: homogeneously hyperintense
    • T1 C+ (Gd): homogeneously enhancing
  • type 2
    • T1: homogeneously/heterogeneously hyperintense
    • T2: heterogeneously hyperintense
    • T1 C+ (Gd): rim-enhancing

The release of intracellular contents (e.g. myoglobin) can result in the development of cardiac arrhythmias, acute renal failure (~30%) and tetanus. Muscle edema may lead to compartment syndrome. Full recovery with early treatment. 

For MRI appearances consider:

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Cases and figures

  • Case 1: right gluteal muscles
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