Clinics in diagnostic imaging (179)

Abstract

A 32-year-old Chinese man with a history of recurrent seizures, depression and multiple suicide attempts by drug overdose presented to the emergency department with severe right lower limb pain and swelling of three days' duration. He suffered an episode of seizure upon admission. On examination, the right thigh and calf were significantly swollen and tender. There was no significant neurovascular compromise of the right lower limb. Laboratory markers revealed significant elevation of serum creatine kinase (CK) level at > 4,100 U/L and urine myoglobinuria at 1,409 μg/L. Serum creatinine was also elevated at 329 μmol/L. Mild hyperkalaemia was noted at 5.5 mmol/L. A review of the patient's medications revealed that he had been on multiple prescription drugs, notably the selective serotonin receptor inhibitor (SSRI) escitalopram 15 mg every night for depression. Magnetic resonance (MR) imaging of the pelvis and right thigh

MRI of myositis and other urgent muscle-related disorders

“…The rim-enhancing foci represent areas of myonecrosis [ 20 ]. The MR findings of type 2 rhabdomyolysis are found in patients with overdose compartment syndrome (ODCS), blunt trauma, vascular occlusion, and carbon monoxide poisoning [ 24 ]. Intramuscular hemorrhage can be seen as hyperintense T1-weighted signal abnormalities and signal void or blooming artifacts on gradient-echo sequences [ 24 ] (Fig.…”