Calcific Myonecrosis of the Upper Extremity: Case Report

Rynders, Sara D.; Boachie-Adjei, Yaw; Gaskin, Cree M.; Chhabra, Arvind

doi:10.1016/j.jhsa.2011.09.035

Cited by 12 publications

(11 citation statements)

References 29 publications

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“…The location of disease in the present report was consistent with previous reports. However, calcified myonecrosis at other areas has also been reported such as at the forearm [10] and foot [11]. The onset of this condition usually presented in the sixth and seventh decades of life but there were reports which showed this disease could happen in a wide range of ages from the third decade to the seventh decade [10,12].…”

Section: Discussionmentioning

confidence: 99%

“…However, calcified myonecrosis at other areas has also been reported such as at the forearm [10] and foot [11]. The onset of this condition usually presented in the sixth and seventh decades of life but there were reports which showed this disease could happen in a wide range of ages from the third decade to the seventh decade [10,12]. The intervals from history taking of the injuries until the patients’ visits for treatment varied from 10 to 60 years according to reports [12].…”

Section: Discussionmentioning

confidence: 99%

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Calcific myonecrosis following snake bite: a case report and review of the literature

et al. 2014

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IntroductionCalcific myonecrosis is a rare condition in which muscle in a limb compartment undergoes necrosis and becomes peripherally calcified with central liquefaction. The patient usually presents with a slowly progressive enlarged mass that sometimes can be misdiagnosed as soft tissue sarcoma. Most of the reported cases showed that the disease occurs often after trauma or compartment syndrome. However, the case of calcific myonecrosis following snake bite is rarely reported.Case presentationA 66-year-old Thai woman presented with a gradually progressive enlarged mass over a period of 10 years in her left leg. She had a history of untreated compartment syndrome after she was bitten by a snake (Malayan pit viper) in her left leg when she was 14-years old. At presentation, a plain X-ray showed a large soft tissue mass at the anterior compartment of her left leg. A sheet-like mass with an enlarged central cavity combined with peripheral calcification and cortical erosion of her tibia were observed. A biopsy was performed and the result was negative for neoplastic cells. During a 5-year follow-up, the mass progressively enlarged and then became infected and finally broke through the skin. She was treated by excision of the mass and administration of antibiotics. The wound completed healed at 1 month postsurgery. There was no wound complication or disease recurrence at 1 year postoperation.ConclusionsThe diagnosis of calcific myonecrosis was done by history taking and radiographic interpretation. In an asymptomatic patient the management should be observation and clinical follow-up. A biopsy should be avoided due to the high rate of postoperative infection. Treatment of choice in a symptomatic condition is mass excision.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Calcific myonecrosis following snake bite: a case report and review of the literature

et al. 2014

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“…It has been hypothesized that compartment syndrome after trauma causes ischemia with recurrent bleeding and necrosis, resulting in fibrosis and subsequent calcification. 5 Only 2 cases involving the forearm 6 , 7 have been reported, and our case 1 is the first case of CM affecting the arm. CM is reportedly associated with compartment syndrome, 2 which is rare in the arm, and this may explain why CM is also rare in the arm.…”

Section: Discussionmentioning

confidence: 64%

“… 8 , 9 Diagnostic biopsy is generally avoided owing to a high risk of infection (~30%). 7 The general consensus is that asymptomatic CM should be conservatively managed, and it can be considered a “do not touch” lesion. 2 In the case of infected CM, antibiotic treatment via the bloodstream is insufficient because of its avascularity, and extensive debridement is required.…”

Section: Discussionmentioning

confidence: 99%

Management of Infected Calcific Myonecrosis: A Report of 2 Cases

Nagano

Yamamoto

Yanagibayashi

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Summary: Calcific myonecrosis (CM) is a rare condition in which a large calcified mass develops after trauma. Generally, CM occurs in a lower extremity, and there have been no reports of its occurrence in the upper arm. We report 2 cases of infected CM, including a rare case of CM occurrence in the arm and a typical case in the leg. Case 1: An 84-year-old woman presented with a draining sinus and a large calcified mass in the arm and axillary region. The mass involved the neurovascular bundle; thus, complete resection was impossible. We performed surgical debridement and postoperative negative-pressure wound therapy with instillation and dwell. Case 2: A 43-year-old man presented with a large calcified mass in the right leg and 2 draining sinuses. After surgical debridement, negative-pressure wound therapy was initiated. However, the wound became infected, and we performed additional debridement, followed by a split thickness skin grafting. The infection was controlled in both patients, although complete resection was not feasible. Complete resection is generally considered the optimum treatment for infected CM, but it is difficult to achieve in some patients. Negative-pressure wound therapy with instillation and dwell appears as a good option for postoperative management if complete resection of infected CM cannot be achieved.

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“…The condition mostly occurs in the anterior compartment of the lower limb and, in rare cases, in the upper extremity. [ 1 ] The condition usually manifests as a firm and enlarging mass with or without pain several decades following the initial trauma, sometimes accompanied by multiple discharge sinuses or infections. [ 2 ]…”

Section: Introductionmentioning

confidence: 99%

Management of calcific myonecrosis with a sinus tract

2018

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Rationale:Calcific myonecrosis is a very rare late sequela that occurs in patients who have had trauma accompanied by vascular compromise, in which a single muscle or entire muscles in a compartment undergoes necrosis and form a calcified mass. It is mostly a benign entity, but some cases cause bone destruction and form non-healing chronic sinuses. In such cases, wound management becomes difficult and there is a potential risk of secondary infection.Patient concerns:A 60-year-old male was referred for evaluation of a pain, erythematous changes, and draining sinus of the anterolateral aspect of his left leg. He had an open reduction and internal fixation as well as a stent insertion in the femoral artery owing to a distal femur fracture and femoral artery rupture.Diagnoses:A thick fluid with a chalk-like material was discharged through the shiny skin via the sinus. The radiographs of the left leg showed a large, fusiform-shaped, radiopaque soft tissue mass in the space between the tibia and fibula. We performed an incisional biopsy to differentiated soft tissue sarcoma and malignant cells were found. Pathologic evaluation revealed acute and chronic inflammation with dystrophic calcification. These findings led to the diagnosis of calcific myonecrosis.Interventions:We performed an extensive debridement of the anterior and deep posterior compartments to ensure definitive treatment. Upon performing extensive debridement, we inserted a drain tube and performed primary closure.Outcomes:The fluid continued to be discharged through the drain even after the surgery; delayed wound healing occurred 4 weeks following the surgery, and there was no recurrence at follow-up conducted 2 years later.Lessons:Calcific myonecrosis is mostly a benign entity, but some cases of calcific myonecrosis cause bone destruction and form non-healing chronic sinuses. In such cases, surgical treatment is required, during which the necrotic tissue and calcific material must be extensively debrided and drained.

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Calcific Myonecrosis of the Upper Extremity: Case Report

Cited by 12 publications

References 29 publications

Calcific myonecrosis following snake bite: a case report and review of the literature

Calcific myonecrosis following snake bite: a case report and review of the literature

Management of Infected Calcific Myonecrosis: A Report of 2 Cases

Management of calcific myonecrosis with a sinus tract

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