A 44-year-old woman with well controlled diabetes presented with intense pain in the left femur and local edema. Creatine kinase levels were slightly elevated. A diabetic myositis diagnosis was established. Diabetic muscle infarction occurs most commonly in insulin-dependent patients (85%) with poorly controlled diabetes and concomitant end-organ complications. Average time of insulin use prior to diagnosis is 14 years. There is equal gender involvement. The pathogenesis of diabetic myonecrosis is unclear. Theories include occlusive peripheral vascular disease in the affected muscles, implicating arteriosclerosis obliterans as a cause of the inadequate perfusion and resultant ischemia. Other theories include endothelial damage from microangiopathy with an activated coagulation cascade, eventually causing a hypercoagulable state leading to ischemia and subsequent muscle necrosis. Case submitted by- Dr Nikos Vougioukli
1 comment:
Hi Dr. Vougioukli and Dr. Sethi,
This is an outstanding example of diabetic myonecrosis. Thanks for taking the time to share.
One of the imaging differential considerations is abscess. However, with careful review of the images in the context of clinical findings, the correct diagnosis can be made as was fortunately done so in this patient.
While biopsy and aspiration are good considerations in the case of abscess. Biopsy is NOT indicated in these patients.
Best regards,
Brian Sabb
www.linkedin.com/in/briansabb
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