Muscle Infarction in Patients with Diabetes Mellitus: MR Imaging Findings

Jelinek, James S.; Murphey, Mark D.; Aboulafia, Albert J.; Dussault, Robert G.; Kaplan, Phoebe A.; Snearly, William N.

doi:10.1148/radiology.211.1.r99ap44241

Cited by 160 publications

(131 citation statements)

References 27 publications

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“…MRI typically shows diffuse muscle oedema with necrosis and increased signal in T2-weighted, inversion-recovery, and gadolinium enhanced images and isointense or hypointense areas on T1-weighted images [13]. The combination of this with normal or slightly elevated inflammatory markers and CPK are highly suggestive of diabetic myonecrosis.…”

Section: Discussionmentioning

confidence: 99%

Diabetic Myonecrosis Mimicking Acute Compartment Syndrome of the Thigh

Hachem¹

2017

MOJOR

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Section: Discussionmentioning

confidence: 99%

Diabetic Myonecrosis Mimicking Acute Compartment Syndrome of the Thigh

Hachem¹

2017

MOJOR

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“…Fever is uncommon, and, if present, one should actively look for an infective pathology (7). The thigh muscles are affected in 81% to 87% of cases, and the calf in 13% to 19% of cases, with bilateral involvement in approximately 40% of patients (8). The most commonly involved muscles are the quadriceps (62%), hip adductors (13%), hamstrings (8%) and hip flexor muscles (2%).…”

Section: Discussionmentioning

confidence: 99%

Multifocal Diabetic Muscle Infarction: A Rare Complication of Poorly Controlled Diabetes Mellitus

Chebbi¹,

Jerbi²,

Klii

et al. 2014

Intern. Med.

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Diabetic muscle infarction (DMI) is a rare complication of long-standing poorly controlled diabetes mellitus. We herein describe the case of a 56-year-old man with a 10-year history of poorly controlled type 2 diabetes mellitus with multiple microvascular and macrovascular complications who presented with the sudden onset of left thigh pain and swelling. MRI suggested muscle infarction. A muscle biopsy demonstrated coagulation necrosis in the skeletal muscle with inflammation and infarction in the walls of small blood vessels. Physicians should consider DMI in the differential diagnosis of patients with diabetes who present with painful, swollen muscles without systemic signs of infection.

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“…Since then, considerable experience has accumulated through case reports and review of previously published cases. [2][3][4][5][6][7][8][9][10][11][12][13][14] Diabetic muscle infarction is a distinct entity with characteristic clinical and radiological findings. It is probably more common than previously recognized.…”

Section: Discussionmentioning

confidence: 99%

“…This is best demonstrated on T2-weighted, inversion-recovery and a gadolinium-enhancedsequence. 5,12 Histological features of DMI consist of a large area of muscle necrosis and edema. Regeneration of the muscle fibers, and polymorphonuclear and lymphocytic interstitial infiltrates may be present.…”

Section: Discussionmentioning

confidence: 99%

Diabetic Muscle Infarction – An Often Missed Complication

2003

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M Hammoudeh, I Khanjar, S Mehdi, Diabetic Muscle Infarction -an Often Missed Complication. 2003; 23(6): 394-396 Diabetic muscle infarction (DMI), or myonecrosis, is an uncommon and often missed complication of diabetes. It occurs in both types of diabetes, but more often in type 1 and appears to be attributable to microangiopathy. It has a characteristic clinical presentation, including acute onset of painful swelling most commonly in the thigh or calf muscles in the absence of systemic manifestation. It is frequently misdiagnosed clinically as neoplasm, abscess, focal myositis, or deep vein thrombosis. Magnetic resonance imaging (MRI) is extremely helpful in making the diagnosis and excluding other possibilities. It usually improves gradually to complete resolution within weeks to a few months. The two cases described emphasize the importance of early recognition and diagnosis of this complication to avoid an unnecessary intervention or hazardous treatment. CaseCase 1. A 62-year-old female patient presented with a three-day history of pain and swelling of the left leg, which had gradually increased over the last 24 hours prior to admission. There was no history of trauma, fever or previous history of similar episodes. She had had diabetes mellitus type 2 for 22 years and had been on insulin therapy for the last 5 years. She also had had hypertension for 4 years and had developed diabetic nephropathy 2 years ago. On physical examination the left calf muscle was swollen and tender, but the foot was neither swollen nor tender. A presumptive diagnosis of deep vein thrombosis (DVT) was made and she was treated with heparin. Laboratory investigation revealed WBCs of 10,700/ mm 3 with 85% granulocytes, creatinine 2.4 mg/dL, and creatinine kinase 340 IU/L (normal up to 170 IU/ L). Doppler ultrasound of the calf, done on the next day, showed edema of the gastrocnemius muscle with no evidence of DVT. Arterial Doppler study showed significant obstruction of the anterior tibial artery. MRI of the legs (Figure 1) showed swelling and high signal intensity in T2-weighted images in the left gastrocnemius and soleus muscles with subcutaneous edema. A diagnosis of DMI was made. Heparin was replaced by analgesics and the patient was advised to rest in bed. The swelling subsided significantly within 4 weeks and almost returned to normal after 8 weeks with disappearance of the pain.

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Muscle Infarction in Patients with Diabetes Mellitus: MR Imaging Findings

Abstract: Diabetic muscle infarction is suggested in diabetic patients with sudden onset of severe pain in the thigh or calf muscles who have MR imaging findings of diffuse edema and swelling of multiple thigh and calf muscles (often in more than one compartment).

Cited by 160 publications

References 27 publications

Diabetic Myonecrosis Mimicking Acute Compartment Syndrome of the Thigh

Diabetic Myonecrosis Mimicking Acute Compartment Syndrome of the Thigh

Multifocal Diabetic Muscle Infarction: A Rare Complication of Poorly Controlled Diabetes Mellitus

Diabetic Muscle Infarction – An Often Missed Complication

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