Focal Myositis-MRI
Case Report: 40 yr old male complaints of pain left calf muscles with occasional fever and no hx of trauma, shows on MRI enlargement/ oedema/ maintained fat planes of tibialis anterior/ flexor digitorium longus/ both heads of gastrocnemius (medial>lateral) with no focal necrosis/ vascular or skeletal abnormality, possibly representing focal myositis
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Teaching points by Dr MGK Murthy, MRI tech: Mr Ram Mohan
1. Focal myositis is a benign inflammatory pseudo tumour when it is not part of the collagen disorders spectrum including polymyositis. Clinically may present with non traumatic pain in a muscle or groups of muscles of short duration with no significant systemic symptoms or laboratory contribution(including viral markers and muscle enzymes/ leukocyte count etc) except possible increase in C-Reactive protein
2. X-rays show no skeletal involvement and Doppler excludes any vascular compromise. MRI is highly sensitive and specific with focal oedema of concerned muscles (type1- part of one muscle involved, type2 whole of one muscle , type 3 represents a group of muscles in a compartment) with enlargement (T1 low and T2/fat sat bright) , maintained inter muscular fat planes with no bleed or vessels or skeletal abnormality
3. Etiology could be viral or denervation variety , with lower extremity predominance ( gastrocnemius/ vastus lateralis / Adductors >others) with no gender / age predilection. Three phase bone scan suggests focal calf muscle activity with bone normal
4.Needle electromyography may demonstrate possible denervation potentials.Usually self limiting and if need be, management with steroids / supportive therapy would help, though may recur rarely
Focal Myositis-MRI
Reviewed by Sumer Sethi
on
Friday, November 13, 2015
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