Magnetic resonance imaging of painful swollen legs in the emergency department: a pictorial essay

Chawla, Ashish; Dubey, Niraj; Chew, Kian Ming; Singh, Dinesh; Gaikwad, Vishal; Peh, Wilfred C.G.

doi:10.1007/s10140-017-1514-6

Cited by 7 publications

(4 citation statements)

References 24 publications

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“…Elevated white blood cells (WBCs) have also been commonly seen in multiple cases. An MRI scan is usually recommended for further evaluation [ 8 ]. It typically reveals signal intensity in the affected intramuscular and subcutaneous tissues, a hyperintense signal on T2-weighted imaging, and an isointense to hypointense signal on T1-weighted images associated with inflammatory changes and edema.…”

Section: Discussionmentioning

confidence: 99%

“…The clinical manifestations and diagnostic findings of diabetic myonecrosis overlap with other etiologies; therefore, a diagnosis can only be established by excluding other etiologies such as pyomyositis, spontaneous gangrenous myositis, nontraumatic clostridial myonecrosis, and necrotizing fasciitis. A tissue biopsy is the definitive diagnostic test, but it is not often recommended for diagnosis, particularly in patients with concomitant diabetes complications, long-standing diabetes, and the absence of other probable etiologies [ 8 ]. Other tests, such as Doppler ultrasound, can rule out differential diagnosis of deep venous thrombosis or bacterial infection of the affected muscle.…”

Section: Discussionmentioning

confidence: 99%

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A Rare and Unique Complication of Uncontrolled Type 2 Diabetes Mellitus: A Case Report and Literature Review of Spontaneous Diabetic Myonecrosis

Johnson¹,

Oo²,

Oo³

et al. 2023

Cureus

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There are many microvascular and macrovascular complications regarding uncontrolled diabetes mellitus (DM). Among them, diabetes myonecrosis is one of the complications but rarely seen in the uncontrolled DM patient population. Here, we present a rare case of DM myonecrosis in a patient with elevated hemoglobin A1c (HbA1c) of 18.2% and discuss the literature review of diabetes myonecrosis. A 48-year-old male with hypertension and uncontrolled type 2 diabetes mellitus (T2DM) with hemoglobin A1c of 18.2% presented with progressive swelling and pain in the right thigh for two days. Physical examination demonstrated swollen and tense tender right thigh with a circumference five inches larger than the left. Computed tomography (CT) and magnetic resonance imaging (MRI) results revealed severe myositis of the right leg, likely myonecrosis, and associated fascial edema/fasciitis. The patient was also complicated with diffuse anasarca, which was corrected with albumin transfusion and furosemide. Aspirin and lisinopril were also started for antithrombotic and cardioprotective effects. The right thigh swelling improved, and the patient could ambulate with supportive measures and regular physical therapy (PT). He was discharged home after 45 days of hospitalization. Diabetic myonecrosis is a rare condition and hence is underdiagnosed. In patients with uncontrolled diabetes, especially with diabetic complications, physicians should have high clinical suspicion to diagnose diabetic myonecrosis when patients present with an acute unilateral painful swollen limb. Our case highlights the complicated course of diabetes myonecrosis with anasarca, improved with supportive measures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Rare and Unique Complication of Uncontrolled Type 2 Diabetes Mellitus: A Case Report and Literature Review of Spontaneous Diabetic Myonecrosis

Johnson¹,

Oo²,

Oo³

et al. 2023

Cureus

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“…10 The most commonly affected muscles reported are the thigh muscles: vastus medialis, followed by vastus lateralis, the vastus intermedius, the rectus femoris, the soleus and the gastrocnemius. 11 Almost all cases reported involved limb muscles, and no case involving axial skeletal musculature was reported. Biopsy is not routinely required for management nor is recommended as it only increases the morbidity without much help in diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Diabetic myonecrosis in end-stage renal disease

Naredi

Adhikari

Bhardwaj

et al. 2022

NMJI

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Diabetic myonecrosis or muscle infarction (DMI), a clinicoradiological entity is an underdiagnosed complication of diabetes mellitus. It refers to spontaneous aseptic necrosis of skeletal muscles commonly of the lower limb without evidence of any large vessel disease. It presents as painful swollen limb without any external insult in patients with long-standing diabetes mellitus with other microvascular complications especially nephropathy. We present four instances of DMI in our patients who had end-stage renal disease with a varied course.

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“…Additional imaging is not necessary but may be performed to exclude other diagnoses as appropriate. Differential diagnoses include DVT, pyomyositis, necrotizing fasciitis, soft tissue abscess, ruptured Baker's cyst, osteomyelitis, and benign tumors or muscle sarcomas [ 6 ]. Muscle biopsy must be reserved for atypical presentation, uncertain diagnosis, or when treatment fails to improve symptoms.…”

Section: Discussionmentioning

confidence: 99%

Diabetic Myonecrosis: A Diagnostic and Treatment Challenge in Longstanding Diabetes

Lawrence

Tovar-Camargo

Lansang

et al. 2018

Case Reports in Endocrinology

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Objective Diabetes mellitus is associated with microvascular and macrovascular complications; the most commonly recognized ones include diabetic nephropathy, retinopathy, and neuropathy. Less well-known complications are equally important, as timely recognition and treatment are essential to decrease short- and long-term morbidity. Methods Herein, we describe a case of a 41-year-old female with longstanding, uncontrolled type 2 diabetes, who presented with classical findings of diabetic myonecrosis. Results Our patient underwent extensive laboratory and imaging studies prior to diagnosis due to its rarity and similarity in presentation with other commonly noted musculoskeletal conditions. We emphasize the clinical presentation, laboratory and imaging findings, treatment regimen, and prognosis associated with diabetic myonecrosis. Conclusion Diabetic myonecrosis is a rare complication of longstanding, poorly controlled diabetes mellitus. The diagnosis requires a high index of suspicion in the right clinical setting: acute onset nontraumatic muscular pain with associated findings on clinical exam, laboratory studies, and imaging. While the short-term prognosis is good, the recurrence rate remains high and long-term prognosis is poor given underlying uncontrolled diabetes and associated sequelae.

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Magnetic resonance imaging of painful swollen legs in the emergency department: a pictorial essay

Cited by 7 publications

References 24 publications

A Rare and Unique Complication of Uncontrolled Type 2 Diabetes Mellitus: A Case Report and Literature Review of Spontaneous Diabetic Myonecrosis

A Rare and Unique Complication of Uncontrolled Type 2 Diabetes Mellitus: A Case Report and Literature Review of Spontaneous Diabetic Myonecrosis

Diabetic myonecrosis in end-stage renal disease

Diabetic Myonecrosis: A Diagnostic and Treatment Challenge in Longstanding Diabetes

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