Diabetic myonecrosis
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Diabetic myonecrosis is an uncommon complication of diabetes mellitus, occurring in patients with chronic poor glycemic control.
Epidemiology
There is a slight predilection for females and patients with type 1 diabetes. Average age of presentation is 40 years.
Clinical presentation
Patients present with painacute onset of pain, tenderness, and swelling, more often in the lower limbs, with the thigh being the most common site.
Pathology
The exact cause is unknown but diabetic myonecrosis is a skeletal muscle injury fromthought to be from atherosclerotic occlusion, hypoxia-reperfusion or vasculitis with thrombus.
Location
Diabetic myonecrosis most commonly affects the lower limbs 7:
- quadriceps (~60%)
- hip adductors (~15%)
- hamstrings (~10%)
- hip flexors (~2%)
Radiographic features
CT
- diffuse muscle enlargement with decreased attenuation
- hyperattenuating subcutaneous fat 2
MRI
MRI findings are non-specific, but a mass-like area of muscle necrosis is noted along with diffuse fascial and subcutaneous soft-tissue oedema 1,2,5,6:
- T1: iso to hypointense
- T2 FS: enlarged muscle(s) with diffuse high signal
- Gad C+: heterogeneous/peripheral enhancement
Differential diagnosis
-
infection, e.g. pyomyositis,necrotising fasciitis, abscess, cellulitis acute compartment syndrome
Treatment and prognosis
Normally responds well to conversative treatment and is self-limiting. High (>50%) recurrence rates are reported 2,3. Prognosis is poor with most patients dying within five years 4.
History and etymology
Diabetic myonecrosis was first described by Angervall and Stener in 1965.
Differential diagnosis
- infection, e.g. infectious myositis, necrotising fasciitis, abscess, cellulitis
- acute compartment syndrome
- malignancy
See also
-<p><strong>Diabetic myonecrosis</strong> is an uncommon complication of diabetes mellitus, occurring in patients with chronic poor glycemic control. </p><h4>Epidemiology</h4><p>There is a slight predilection for females and patients with type 1 diabetes. </p><h4>Clinical presentation</h4><p>Patients present with pain, tenderness, and swelling, more often in the lower limbs, with the thigh being the most common site. </p><h4>Pathology</h4><p>The exact cause is unknown but diabetic myonecrosis is a skeletal muscle injury from atherosclerotic occlusion, hypoxia-reperfusion or vasculitis with thrombus. </p><h4>Radiographic features</h4><h5>CT</h5><ul>- +<p><strong>Diabetic myonecrosis</strong> is an uncommon complication of <a href="/articles/diabetes-mellitus">diabetes mellitus</a>, occurring in patients with chronic poor glycemic control. </p><h4>Epidemiology</h4><p>There is a slight predilection for females and patients with type 1 diabetes. Average age of presentation is 40 years. </p><h4>Clinical presentation</h4><p>Patients present with acute onset of pain, tenderness, and swelling, more often in the lower limbs, with the thigh being the most common site. </p><h4>Pathology</h4><p>The exact cause is unknown but diabetic myonecrosis is a skeletal muscle injury thought to be from atherosclerotic occlusion, hypoxia-reperfusion or vasculitis with thrombus. </p><h5>Location</h5><p>Diabetic myonecrosis most commonly affects the lower limbs <sup>7</sup>:</p><ul>
- +<li>quadriceps (~60%)</li>
- +<li>hip adductors (~15%)</li>
- +<li>hamstrings (~10%)</li>
- +<li>hip flexors (~2%)</li>
- +</ul><h4>Radiographic features</h4><h5>CT</h5><ul>
-</ul><h5>MRI</h5><p>MRI findings are non-specific, but a mass-like area of muscle necrosis is noted <sup>1,2,5,6</sup>:</p><ul>- +</ul><h5>MRI</h5><p>MRI findings are non-specific, but a mass-like area of muscle necrosis is noted along with diffuse fascial and subcutaneous soft-tissue oedema <sup>1,2,5,6</sup>:</p><ul>
-</ul><h4>Differential diagnosis</h4><ul>-<li>infection, e.g. pyomyositis, <a href="/articles/necrotising-fasciitis">necrotising fasciitis</a>, abscess, cellulitis</li>- +</ul><h4>Treatment and prognosis</h4><p>Normally responds well to conversative treatment and is self-limiting. High (>50%) recurrence rates are reported <sup>2,3</sup>. Prognosis is poor with most patients dying within five years <sup>4</sup>. </p><h4>History and etymology</h4><p>Diabetic myonecrosis was first described by <strong>Angervall </strong>and <strong>Stener </strong>in 1965. </p><h4>Differential diagnosis</h4><ul>
- +<li>infection, e.g. <a href="/articles/infectious-myositis">infectious myositis</a>, <a href="/articles/necrotising-fasciitis">necrotising fasciitis</a>, abscess, cellulitis</li>
-</ul><h4>Treatment and prognosis</h4><p>Normally responds well to conversative treatment and is self-limiting. High (>50%) recurrence rates are reported <sup>2,3</sup>. Prognosis is poor with most patients dying within five years <sup>4</sup>. </p><h4>History and etymology</h4><p>Diabetic myonecrosis was first described by <strong>Angervall </strong>and <strong>Stener </strong>in 1965. </p><h4>See also</h4><ul>- +<li>malignancy</li>
- +</ul><h4>See also</h4><ul>
References changed:
- 7. Bhasin R, Ghobrial I. Diabetic myonecrosis: a diagnostic challenge in patients with long-standing diabetes. J Community Hosp Intern Med Perspect. 2013;3 (1): . <a href="http://dx.doi.org/10.3402/jchimp.v3i1.20494">doi:10.3402/jchimp.v3i1.20494</a> - <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3716030">Free text at pubmed</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/23882392">Pubmed citation</a><span class="auto"></span>
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