Muscle edema secondary to calf DVT on MRI

Case contributed by Chris O'Donnell

Presentation

Known leukocytoclastic vasculitis. Now severe right calf pain, ? myositis

Patient Data

Age: 40
Gender: Male

MRI to detect sites of myositis prior to targetted biopsy

mri

Diffuse edema in the gastrocnemius and soleal muscles of the right leg associated with expansion of the calf veins filled with T1 and T2 hyperintense material indicative of clot.  All other calf and thigh muscles are normal.  Note left calf veins do not contain T1 hyperintensity i.e. methemoglobin.

Case Discussion

MRI (especially STIR imaging) is exquisitely sensitive to muscle edema and can be used to localize sites of muscle swelling that be targetted for biopsy (to diagnose myositis).  It is, however, no specific as in this case i.e. the patient has muscle swelling not due to inflammation rather due to venous obstruction by thrombosis.

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