Calcific myonecrosis of the lower leg: diagnosis and options of treatment

Abstract

The key points for diagnosis were (1) amorphous liner calcification, (2) anterior or lateral compartment, (3) previous injury (several decades) of the tibia or femur, and (4) compartment syndrome. Although calcific myonecrosis is not commonly encountered, it must be considered in the differential diagnosis of an expanding intramuscular mass. In asymptomatic masses where the diagnosis is recognized, observation may be possible and unnecessary aggressive surgical intervention should be avoided.

Calcific Myonecrosis of the Leg: Report of Three Patients Presenting with Infection

“…On MRI, the lesions appear heterogeneous on both T 1 -and T 2 -weighted images with some areas of hyperintensity on the latter reflecting the cystic change. The outer rim shows low signal intensity resulting from the calcification and fibrosis [7,8]. Sonographic imaging also may be useful [9].…”

Calcific Myonecrosis of the Upper Extremity: Case Report

“…Occasionally, the mass will be asymptomatic. 3,[5][6][7] The initial injury is usually a crush, fracture, or blunt trauma that caused vascular compromise or an untreated compartment syndrome 10 to 64 years before the presentation of the mass (average, 51 y after injury). 2,4 There is one report of calcific myonecrosis in a patient with a history of juvenile dermatomyositis and no history of trauma.…”

“…3,9,32 The interior reveals necrotic tissue with amorphous debris composed of cholesterol crystals, fibrin, and organizing thrombus 9 appearing grossly as a thick reddish-brown liquid or paste. 2,3,5,6,32 Calcific myonecrosis can be confidently diagnosed on radiographic and MRI studies due to its unique imaging characteristics. 4,7,9,32 Calcific myonecrosis is usually first identified on plain radiographs as a fusiform mass, with its long axis paralleling the extremity and containing plaque-like, linear, or amorphous calcifications within an atrophied muscular compartment.…”

“…5 Observation, therefore, is becoming the preferred method of treatment for asymptomatic calcific myonecrosis, given a better understanding of the natural history of the disease and improving imaging techniques that allow for better visualization and characterization of calcific lesions. [3][4][5][6]32 Surgery might be indicated when (1) there is an infection or draining sinus that requires incision and drainage, (2) the patient's history and advanced imaging do not provide a clear diagnosis of calcific myone-FIGURE 2: Restricted motion limited conventional positioning of the arm for imaging. A Anteroposterior and B lateral plain radiographs show a fusiform, densely calcified mass in a severely atrophied forearm.…”

MRI of Muscle Injuries

“…On MRI, the mass is diffusely T2 hyperintense/fluid signal, while other areas of the lesion demonstrate heterogeneous, intermediate signal (Muramatsu et al 2009;Ryu et al 1996).…”