Calcific myonecrosis: keys to early recognition

Abstract

Calcific myonecrosis is a rare, late sequela of trauma occurring almost exclusively in the lower extremity which may be confused with an aggressive primary neoplasm. The platelike mineralization pattern seen on radiographs is characteristic but not widely recognized by clinicians. Three cases of calcific myonecrosis are reported, unique in that two presented for care following infection and that one had extended to involve the muscle compartments of the foot, a previously unreported site.

Massive ectopic calcification of muscles in the lower leg following femoral artery injury—a case report

“…The calcification in calcific myonecrosis was either scattered within the necrotic muscle or peripherally around a fusiform mass (O'Keefe et al 1995, Snyder et al 1995, Zohman et al 1998, Wang and Chen 2001, Holobinko et al 2003. On the contrary, in our case, the entire anterior and lateral compartments were replaced by calcified material without any viable tissue.…”

Calcific myonecrosis following snakebite

“…5 Spontaneous soft tissue breakdown with sinus formation was seen in one of our cases and in the case reported by Yuenyongviwat et al 18 Patients with calcific myonecrosis should be followed closely so that early intervention can be initiated once soft tissue breakdown occurs.…”

“…[4][5][6] Differential diagnosis includes synovial sarcoma and soft tissue osteosarcoma as well as benign conditions like myositis ossificans, dermatomyositis, tumoral calcinosis and calcific tenosynovitis ( Table I). 5 We report two similar cases of calcific myonecrosis of the anterior compartment of the lower leg following snakebites and review the available literature on this rare condition.…”

Orthopaedic Case of the Month: Painful Lower-leg Mass in a 76-year-old Man

“…Biopsy should be considered only if the diagnosis cannot be made by history and review of imaging studies. Surgery generally is not recommended owing to complications such as blood loss, chronic draining fistulae, secondary infection, and resultant transtibial amputations [11,13,16,21,31]. Therefore, in the rare cases where symptoms prompt surgery, the considerable risks and benefits always should be reviewed carefully with the patient.…”