Presentation
History of pain and swelling right thigh since 1 month associated with intermittent type of mild fever. No history of diabetes and trauma.
Patient Data
Right femur, proximal end of tibia and visualized part of hip joint appear normal.
There is T1 iso to slightly high/ T2 and STIR heterogeneous and predominantly high signal intensity involving vastus intermedius, vastus medialis and a small portion of vastus lateralis muscles of the anterior compartment as well as short and long head of biceps femoris of the posterior compartment of thigh. Post-contrast study shows enhancement of these regions.
There are multiple, small, intramuscular and intermuscular fluid collections showing T2 high signal intensity and peripheral rim enhancement on T1 post-contrast study noted within them. However, on DWI/ADC there is no significant diffusion restriction. On GRE, there is no significant blooming artefact. The largest one of them measures 5.3 x 4.4 x 1.2 cm in size and is noted just posterior to the quadriceps tendon in the knee which is communicating with the knee joint cavity. There is a fluid-fluid level seen in T2/ TIRM likely representing debris within the collection.
Small fluid collection showing T2 high signal intensity in the intermuscular septa and in the subcutaneous tissue at the anterior, lateral and posterior aspects of mid and lower thigh.
There is moderate joint effusion noted within the knee joint cavity with enhancement of the synovial lining suggesting synovitis.
Case Discussion
Given the imaging findings and the slow clinical improvement of the patient following antibiotics therapy, in this case, suggests the most likely diagnosis of infectious myositis.
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