Demonstration of CT Hyperdensity in Patients with Acute Renal Failure Associated with Rhabdomyolysis

Russ, Paul; Dillingham, Mark A.

doi:10.1097/00004728-199105000-00021

Cited by 26 publications

(8 citation statements)

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“…The literature suggests that, in some patients, intramuscular calcium deposition occurs in later stages, observed as high attenuation within muscles. 2 Russ and Dillingham 2 reported that CT showed high-attenuation areas in affected muscles at some point in time in 4 of 8 patients. The affected muscles were initially swollen, then calcified, and finally shrank, whereas calcification disappeared.…”

Section: Discussionmentioning

confidence: 97%

“…This finding has been reported on CT in many cases and has been postulated secondary to calcium deposition. 2,3 CT and MR findings of rhabdomyolysis are nonspecific and may be secondary to edema and/or inflammation. Similar findings have been reported in polymyositis, dermatomyositis, mild injuries, infections, myositis, radiation therapy, acute denervation, compartment syndrome, early myositis ossificans, and sickle cell crisis.…”

Section: Discussionmentioning

confidence: 99%

“…Similar findings have been reported in polymyositis, dermatomyositis, mild injuries, infections, myositis, radiation therapy, acute denervation, compartment syndrome, early myositis ossificans, and sickle cell crisis. 2,3,8 In general, it may be reasonable to consider that patients with acute rhabdomyolysis undergo imaging studies if they have symptoms suggesting a compartment syndrome or if their disease is sufficiently extensive as to cause devastating renal damage. Later, in the chronic stage, imaging studies are useful for supporting the diagnosis, evaluating the extent of the pathology, and guiding muscle biopsies.…”

Section: Discussionmentioning

confidence: 99%

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Lateral Pterygoid Muscle Rhabdomyolysis

Jain¹,

Ellingson²,

Smoker³

2007

American Journal of Neuroradiology

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SUMMARY:We report a case of rhabdomyolysis due to acetaminophen overdose involving the lateral pterygoid muscles bilaterally, in addition to the other muscles of the abdomen and pelvis. To the best of our knowledge, involvement of the head and neck muscles by rhabdomyolysis has not been reported previously. The isolated involvement of the lateral pterygoid muscles may be due to the presence of the surrounding pterygoid venous plexus. It is important to be aware of the imaging characteristics of rhabdomyolysis and to consider the possibility of involvement of head and neck muscles to aid in early diagnosis and avoid misinterpretation of the imaging findings. Rhabdomyolysis is defined as disintegration of skeletal muscles that causes myoglobinuria, raised creatine kinase (CK), and renal failure in severe cases.1 CT scans initially show rhabdomyolysis as areas of low attenuation within affected muscles, which may become hyperattenuated in later stages and ultimately normalize, with or without subsequent atrophy.2,3 MR imaging shows hyperintensity on T2-weighted images with avid contrast enhancement on postgadolinium T1-weighted images and may demonstrate T1 hyperintensity later in the course of the disease in some patients. 4 An extensive search of the literature revealed the findings of rhabdomyolysis described in relation to the pelvic and lower extremity muscles but, to the best of our knowledge, this is the first reported case of rhabdomyolysis affecting the head and neck muscles. The lateral pterygoid muscles were selectively involved among the muscles of mastication. We propose that the intimate association of the lateral pterygoid muscles to the pterygoid venous plexus may be the cause of isolated involvement of these muscles. Case ReportA 28-year-old man with long-standing psychiatric problems and suicidal ideation presented to the emergency department after a suicide attempt by ingestion of a large dose of acetaminophen. Initial clinical and laboratory examination were significant for fulminant hepatic failure, acute renal failure, hypotension, respiratory distress, raised CK, metabolic acidosis, hyperkalemia, hypocalcemia, and coagulopathy. His acetaminophen level on admission was 303 g/mL (critical value, Ͼ40 g/mL). The CK increased from 20 -306 U/L (reference, 40 -200 U/L) on hospital day 1 to 245-595 U/L on day 2. The renal failure was managed by hemodialysis, and liver transplant was performed on hospital day 3.A noncontrast CT scan of the brain was performed on hospital day 2 to rule out cerebral edema. The brain was normal but, in retrospect, the study showed lateral pterygoid muscle hypoattenuation bilaterally (Fig 1A). An MR examination of brain was performed on hospital day 16 for suspected stroke. The study was negative for stroke but showed T2 prolongation and homogenous contrast enhancement in the lateral pterygoid muscles bilaterally (Fig 1B-D). Another MR to rule out stroke on day 26 revealed similar findings, though the lateral pterygoid muscles, which were previously isointense, now demons...

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Lateral Pterygoid Muscle Rhabdomyolysis

Jain¹,

Ellingson²,

Smoker³

2007

American Journal of Neuroradiology

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“…In a case of rhabdomyolysis complicating acute renal failure, some previous reports suggested a relation between temporary muscular calcification and abnormal serum calcium concentration due to acute renal failure (hypo/normocalcemia during the diuretic and recovery phases and temporary hyper/ normocalcemia after recovery from acute renal failure). [5][6][7][8][9] Unfortunately, serial serum calcium concentration measurements had not been done in our case. We have no suggestion as to the mechanism.…”

Section: Discussionmentioning

confidence: 99%

Early disappearance of calcification in posterior paraspinal muscles in a patient with rhabdomyolysis associated with neuroleptic malignant syndrome

et al. 2006

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We report computed tomography (CT) findings that demonstrated early disappearance of ectopic calcification in the bilateral posterior paraspinal muscles in a patient with rhabdomyolysis. A 37-year-old man with acute renal failure due to rhabdomyolysis caused by neuroleptic malignant syndrome underwent studies with CT and bone scintigraphy. First, bone scintigraphy showed high radiotracer uptake in bilateral posterior paraspinal muscles; then CT demonstrated ectopic calcification in those muscles. After 2.5 months, CT showed that the calcification had completely disappeared. Bone scintigraphy anticipated calcification, and CT demonstrated a unique course of early disappearance of the calcification.

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“…Ces images bien que non spécifi-ques peuvent orienter le diagnostic dans un contexte évoca-teur [18].…”

Section: Les Techniques D'imagerieunclassified