Denervation pseudohypertrophy of calf muscles associated with diabetic neuropathy

Abstract

Denervation of muscle usually leads to muscle atrophy with fatty replacement but, uncommonly, also results in muscle hypertrophy or pseudohypertrophy with fatty replacement. We report the ultrasonographic and magnetic resonance imaging (MRI) findings of a patient with diffuse fatty infiltration of calf muscles as a result of denervation pseudohypertrophy. The elevated fasting glucose, neurogenic electromyographic changes, and muscle atrophy with adipose tissue infiltration are consistent with diabetic neuropathy as the cause of denervation pseudohypertrophy. Lumbosacral radiculopathy and plexopathy were excluded by MRI. The imaging features reported in the literature are reviewed. The important differential diagnosis of infiltrating lipoma and denervation hypertrophy, as well as other causes of monomelic hypertrophy or swelling, is discussed. This case report demonstrates the importance of MRI, with clinical, biochemical, electrophysiological, and histologic correlation in the diagnosis of denervation pseudohypertrophy. Correct diagnosis of denervation pseudohypertrophy has an important role in guiding further investigations and treatment of the disease and the underlying cause.

Denervation pseudo hypertrophy of the calf: An important cause of lower limb swelling

“…The differential diagnosis of a unilateral swollen calf also includes vascular etiologies, particularly deep venous thrombosis, as well as infection, and tumor. Rarely, congenital conditions such as Klippel-Trenauny or Proteus [7] syndromes can cause limb enlargement.…”

Pseudohypertrophy of the extensor digitorum brevis in diabetic polyneuropathy

“…Bilateral pseudohypertrophy of the calf has been reported in diabetic polyneuropathy. 7 It is possible that the same phenomenon, to varying degrees, may confound the clinical assessment of true muscle bulk in other settings of chronic denervation. This underscores the value of electrodiagnostic studies, and in some cases musculoskeletal imaging, to complement the clinical assessment of neuromuscular disease.…”

“…6Denervation pseudohypertrophy of the EDB is an unusual finding in the setting of polyneuropathy. Bilateral pseudohypertrophy of the calf has been reported in diabetic polyneuropathy 7. It is possible that the same phenomenon, to varying degrees, may confound the clinical assessment of true muscle bulk in other settings of chronic denervation.…”