The value of computed tomography and magnetic resonance imaging to diagnose rhabdomyolysis in acute renal failure

Nakahara, Kumiko; Tanaka, Hiroshi; Masutani, Kosuke; Yanagida, Taihei; Kashiwagi, Masahide; Mizumasa, Tohru; Masuda, Katsutoshi; Hirakata, Hideki; Fujishima, Masatoshi

doi:10.1093/ndt/14.6.1564

Cited by 23 publications

(19 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…When a patient is not admitted immediately, recognition and evaluation of rhabdomyolysis may become difficult. Reports suggest that over one-quarter of patients with rhabdomyolysis are not clinically diagnosed [3,4].…”

mentioning

confidence: 99%

See 1 more Smart Citation

Skeletal muscle evaluation by MRI in a rabbit model of acute ischaemia

Zhang¹,

Wang²,

Guan³

et al. 2013

BJR

View full text Add to dashboard Cite

Objective: To assess rhabdomyolysisassociated skeletal muscle changes induced by complete ischaemia in rabbits using MRI.Methods: Acute ischaemia was induced in the right hind limb of 34 New Zealand white rabbits by arterial ligation. MRI of vastus lateralis was carried out pre-operatively and every hour post-operatively up to 7 h. T 1 weighted images, T 2 weighted images with fat suppression, T 2 maps and diffusion tensor scans were obtained. The correlation of MRI findings with histopathological changes in biopsies of vastus lateralis was examined.Results: Histopathology demonstrated early cellular oedema 1 h post ischaemia and irreversible injuries by 7 h, including loss of striation and broken muscle fibres. T 2 weighted images with fat suppression showed inhomogeneous high signal intensity of vastus lateralis, which progressively increased from 2 h following ischaemia. The T 2 relaxation rate of ischaemic vastus lateralis was significantly greater than normal muscle (p,0.001) and demonstrated a linear increase with time following ischaemia. A similar linear increase was also found in the ischaemic vastus lateralis apparent diffusion coefficient (ADC) 1-5 h post ischaemia (p50.006). Both the T 2 ADC and fractional anisotropy (FA) were significantly higher on the ischaemic side 7 h post ischaemia (for T 2 , p50.02; for ADC, p50.004). Conclusion:Muscle oedema is detectable on MR images and is reflected well by T 2 , ADC and FA values. MRI may have value in clinical evaluation of rhabdomyolysis. Advances in knowledge:Ischaemic changes detected by MRI may have value in the diagnosis of rhabdomyolysis.

show abstract

mentioning

confidence: 99%

“…Review of medical records has shown that MR images can be used to effectively localise muscle lesions in rhabdomyolysis and assess extent [4,[7][8][9][10][11][12]. MRI has been shown to be more sensitive for detection of rhabdomyolysis skeletal muscle lesions than ultrasonography and CT [8].…”

mentioning

confidence: 99%

Skeletal muscle evaluation by MRI in a rabbit model of acute ischaemia

Zhang¹,

Wang²,

Guan³

et al. 2013

BJR

View full text Add to dashboard Cite

show abstract

“…However, these are nonspecific imaging findings that can also be seen in pyomyositis and infiltrative intramuscular neoplasms. (7,10,11) On ultrasonography, affected muscle groups generally appear hypoechoic, with effacement of the normal striated architecture of the muscle fibres, although these findings are also nonspecific. (11,12) In the absence of relevant clinical history and laboratory markers, radiological findings of rhabdomyolysis may be difficult to distinguish from those of inflammatory myopathy, muscle infection, necrotising fasciitis or other conditions associated with myonecrosis such as diabetes mellitus or sickle cell crisis.…”

Section: Discussionmentioning

confidence: 99%

Clinics in diagnostic imaging (179)

Kok¹,

Tan²

2017

smedj

View full text Add to dashboard Cite

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

show abstract

“…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%

Lateral Pterygoid Muscle Rhabdomyolysis

Jain¹,

Ellingson²,

Smoker³

2007

American Journal of Neuroradiology

View full text Add to dashboard Cite

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...

show abstract

The value of computed tomography and magnetic resonance imaging to diagnose rhabdomyolysis in acute renal failure

Cited by 23 publications

References 12 publications

Skeletal muscle evaluation by MRI in a rabbit model of acute ischaemia

Skeletal muscle evaluation by MRI in a rabbit model of acute ischaemia

Clinics in diagnostic imaging (179)

Lateral Pterygoid Muscle Rhabdomyolysis

Contact Info

Product

Resources

About