Diabetic myonecrosis

Case contributed by Dr Yair Glick

Presentation

Swelling and pain in medial aspect of right thigh for past 2 months. Poorly controlled DM with end-organ damage (nephropathy, retinopathy, and PVD).

Patient Data

Age: 60 years
Gender: Male
X-ray

Knee radiographs unremarkable except for atherosclerosis.

Ultrasound

US thighs

There is induration of the vastus medialis muscle with increased echogenicity and an abnormality in echotexture which most probably represents oedema.
Subcutaneous oedema in the thigh.

MRI

MRI thighs

Contrast material not injected due to chronic renal failure.

Right:
Normal bone and joint structure, as well as bone marrow signal of the osseous structures contained in the scan, except for patellar subchondral cysts.
Pronounced swelling of the vastus medialis muscle, particularly its distal half. Diffuse pathological signal of the muscle, heterogeneous in its distal part, probably evidence of loss of normal muscle architecture. Similar, if less intense, changes in the middle part of the vastus intermedius muscle and in several of the muscles in the posterior and lateral thigh.
Subcutaneous oedema and perifascial fluid accumulation around the anterior and lateral compartment.

Left: Normal appearance of osseous and soft tissue structures.

In view of the clinical picture, the findings are most consistent with diabetic myonecrosis.

Case Discussion

Painful muscle swelling in a patient with poorly controlled diabetes mellitus should raise suspicion for diabetic myonecrosis.

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Case information

rID: 56082
Case created: 10th Oct 2017
Last edited: 10th Oct 2017
Inclusion in quiz mode: Included
Institution: Hillel Yaffe Medical Center

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