Diabetes-related denervation pseudohypertrophy of the calf muscles
Presentation
Diabetic. Chronic left leg ulcer for 5 years. Superficial necrosis 2nd and 3rd toes. Peripheral vascular disease?
Patient Data
CTA study of both lower limbs
There is no significant stenosis of the left leg arteries.
However early venous filling is demonstrated, which is a secondary sign of peripheral vascular disease. In addition, there is superficial venous engorgement in the lower left leg.
Of note, the left leg is larger than the right leg. However, there is no edema within the subcutaneous fat of the left leg. There is complete atrophy of the left leg muscles in all compartments, with hypertrophic fat replacement. More minor fat replacement is seen in the superficial posterior compartment of the right leg.
Therefore despite there being complete atrophy of the left leg muscles, the left leg is significantly larger than the right leg.
Case Discussion
Denervation pseudohypertrophy of the calf muscles can be seen with diabetic neuropathy. In this case, there is complete left lower leg muscles atrophy and hypertrophic fat replacement of the muscles resulting in pseudohypertrophy 1,2.
Painless fat hypertrophy of the calf muscles with preservation of the muscles plains is indicative of neurogenic pseudohypertrophy 3.
The CT scanogram image is included with lower leg measurements to illustrate the left leg pseudohypertrophy.
Case presented with Dr N Dodds FRCR.
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