Clinical and Radiologic Features of Spontaneous Muscle Infarction in the Diabetic

Reich, Stephen G.; Wiener, Stephen N.; Chester, S W; Ruff, Robert L.

doi:10.1097/00003072-198512000-00012

Cited by 40 publications

(14 citation statements)

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“…Standard radiographic films are rarely helpful, except to exclude bony abnormalities or soft-tissue calcifications (19). Sonographic findings in DMI include a wellmarginated, hypoechoic, intramuscular lesion with the following additional features: internal linear echogenic structures coursing through the lesion, an absence of internal motion or swirling of fluid transducer pressure, and a lack of a predominantly anechoic area.…”

Section: Pathogenesismentioning

confidence: 99%

Diabetic Muscle Infarction

2003

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OBJECTIVE -To systematically review all the reported cases of diabetic muscle infarction (DMI) and its pathogenesis, clinical features, prognostic implications, and management. RESEARCH DESIGN AND METHODS -We searched databases (MEDLINE and EMBASE) from their inception to August 2001 and reviewed bibliographies in reports retrieved.Data were extracted in a standardized form.RESULTS -A total of 47 references were retrieved; 115 patients and 166 episodes were included. DMI was more frequent in women (61.5%, mean age at presentation 42.6 years). Of the cases, 59% had type 1 diabetes; the mean duration of disease was 14.3 years, and multiple diabetic end-organ complications were noted. DMI affects the lower limbs with abrupt onset of pain and local swelling. Diagnosis is made by biopsy, but the characteristic features in magnetic resonance imaging are very typical. Treatment includes bed rest and administration of analgesics, but recurrence is common.CONCLUSIONS -DMI is a very uncommon complication of long-standing diabetes; presentation is well characterized and management is simple. Diabetes Care 26:211-215, 2003S pontaneous aseptic diabetic muscle infarction (DMI) is a rare complication of diabetes. It has been reported as aseptic myonecrosis, ischemic myonecrosis, and tumoriform focal muscular degeneration. Clinical presentation is uniform, with acute onset of painful swelling of the affected muscle and, occasionally, a palpable mass. The differential diagnosis is extensive and DMI is frequently misdiagnosed clinically. The illness is certainly diagnosed by histological biopsy analysis, although the results of T2-weighted magnetic resonance imaging (MRI) may be sufficient to enable other clinical entities to be excluded, thus avoiding inappropriate diagnosis and treatment (1). Although DMI was first reported in 1965 by Angervall and Stener (2) and seems to be a well-characterized complication of diabetes, only a few cases have been published.The goal of this systematic review was to identify the clinical features, pathogenesis, diagnostic aspects, therapeutic management, and prognosis of DMI. RESEARCH DESIGN AND METHODS Questions askedOur review was designed to answer various questions about DMI regarding clinical features, pathogenesis, diagnosis, microscopic and macroscopic appearance, prognosis, and therapeutic aspects. Identification and retrieval of primary studiesWe searched MEDLINE (OVID Technologies and PubMed), EMBASE (OVID Technologies) using the heading "diabetic muscle infarction" and all synonyms and related terms. Databases were searched from their inception to August 2001.Study selection and data extraction Data were systematically extracted from all retrieved reports. Proportions were used in descriptive analysis, and the denominator corresponded to the number of cases in which the investigated characteristic was described. RESULTS Search resultsAfter searching the electronic databases, we identified 47 reference sources (1-47) that included 115 patients with 166 episodes of DMI. The most frequen...

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Section: Pathogenesismentioning

confidence: 99%

Diabetic Muscle Infarction

2003

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“…Plain radiography [3,9,10], radionuclide bone scanning [8,11], sonography [8,10,12,13], and CT examination [3,11] are all useful but with limited diagnostic value in DMI. The most helpful imaging tool is MRI [14], which is highly characteristic [3,11,14,15] and can provide precise anatomic location of the muscle infarction and is also a safe noninvasive technique for ruling out deep venous thrombosis [16]. On T1-weighted images, the infarcted muscles are either hypointense or isointense relative to the normal muscle.…”

Section: Discussionmentioning

confidence: 99%

Case report: diabetic muscle infarction presenting as knee arthralgia

Yoo

Kim

Park

et al. 2001

Rheumatology International

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Diabetic muscle infarction is a rare complication of diabetes and has characteristic clinical features including acute onset of pain with painful swelling, most commonly in the thigh or calf muscle, which gradually improves to complete resolution. Recently we experienced a case of diabetic muscular infarction presenting as knee joint pain due to involvement of the proximal portion of the leg muscle, which site has not been reported previously. This case shows that diabetic muscle infarction may involve sites other than the thigh and calf areas and should be considered in the differential diagnosis of knee arthralgia.

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“…Over the past 30 years, others have confirmed the histological characteristics of DMI which include in varying amount, haemorrhagic necrosis, regeneration of muscle fibres, active denervation, hyalinosis and thickening of the affected arterioles and capillaries, and lymphocytic infiltration. [3][4][5][6][7][8][9][10][13][14][15][16][17][18][19] Eight years after the initial report, 1 Banker and Chester 3 described two additional cases of patients with diabetes mellitus who developed pain in the thigh followed by swelling and a palpable mass. Both had an excision biopsy, but required reoperation due to recurrent haemorrhage into the infarcted muscle.…”

Section: Discussionmentioning

confidence: 99%

“…While MRI is very helpful in limiting the differential diagnosis and localising the lesion, it may not suffice to distinguish a DMI from a neoplastic process or infection. 5,10,13,14,16,18 In such cases a core-needle biopsy of the muscle is indicated to obtain material for histological evaluation and microbial cultures. 5,9,10,13,14,17 The treatment of DMI is by analgesics and physiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Clinical and radiological aspects of idiopathic diabetic muscle infarction

Aboulafia

Monson

Kennon

1999

The Journal of Bone and Joint Surgery. British volume

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T he systemic effects of diabetes mellitus are well recognised. The heart, kidney, central and peripheral nervous systems, and the distal parts of the limbs are often the site of end-organ damage resulting from ischaemia. Infarction of large muscle groups in the limb, not associated with gangrene, is uncommon. There have been few reported cases other than radiological descriptions of diabetic muscle infarcts. While previous reports have illustrated some of the clinical and radiological characteristics of this condition, the paucity of published cases makes it difficult to determine the most appropriate methods of diagnosis and treatment.During a five-year period we treated 14 patients with diabetes mellitus, aged from 32 to 59 years, who were referred to a musculoskeletal oncology service for suspected soft-tissue sarcoma, but were subsequently found to have a diabetic muscle infarct. Closed needle biopsy was performed in 13 without complications. In 12 patients, the symptoms resolved without surgical treatment.

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Clinical and Radiologic Features of Spontaneous Muscle Infarction in the Diabetic

Cited by 40 publications

References 0 publications

Diabetic Muscle Infarction

Diabetic Muscle Infarction

Case report: diabetic muscle infarction presenting as knee arthralgia

Clinical and radiological aspects of idiopathic diabetic muscle infarction

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