Rhabdomyolysis

Case contributed by Dr Craig Hacking

Presentation

Drug addict found on floor unconscious. CT head normal. Swollen buttocks.

Patient Data

Age: 29
Gender: Male
Modality: CT

There is hypoattenuation and expansion of the right gluteal muscles and piriformis. The inferior limit of this abnormal musculature has not been imaged. Streak artifact is present in the left gluteal region however there is suspicion of a similar but less severe process on this side. Bilateral intermuscular edema. No convincing abnormal enhancement on either side. No soft tissue gas. Right hip joint effusion.

The liver, gallbladder, spleen, pancreas, right kidney and adrenals are unremarkable. Slight hypoattenuation of the left kidney. Colonic faecal loading, otherwise no bowel abnormality.

There is intraperitoneal and pelvic free fluid. NGT and bladder IDC in situ.

Left lower lobe and left lingula consolidation. The right lung base is clear. No pleural effusion.

No destructive osseous lesion. No fracture or dislocation.

Conclusion

  1. Hypoattenuation and expansion of the right gluteal muscles and piriformis represents rhabdomyolysis. A similar but less severe appearance is present on the left side. The inferior limit of the myonecrosis has not been imaged. If further imaging of the right leg is required, MRI would be far superior.
  2. Slightly decreased enhancement of the left kidney may be due to rhabdomyolysis causing acute renal impairment.
  3. Left lung consolidation likely aspiration.

Case Discussion

Great case of reduced muscle attenuation representing myonecrosis from rhabdomyolysis. The patient was placed on dialysis in ICU following the scan allowing us to give IV contrast.

Subtle reduced renal perfusion relfects the renal impairment.

CK was >30,000 and Cr was 300.

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Case Information

rID: 37698
Case created: 18th Jun 2015
Last edited: 1st Dec 2016
Tag: arf
Inclusion in quiz mode: Included

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