Presentation
Swelling and pain in medial aspect of right thigh for past 2 months. Poorly controlled DM with end-organ damage (nephropathy, retinopathy, and PVD).
Patient Data
Knee radiographs unremarkable except for atherosclerosis.
There is induration of the vastus medialis muscle with increased echogenicity and an abnormality in echotexture which most probably represents edema.
Subcutaneous edema in the thigh.
Contrast material not injected due to chronic renal failure.
Right:
Normal bone and joint structure, as well as bone marrow signal of the osseous structures contained in the scan, except for patellar subchondral cysts.
Pronounced swelling of the vastus medialis muscle, particularly its distal half. Diffuse pathological signal of the muscle, heterogeneous in its distal part, probably evidence of loss of normal muscle architecture. Similar, if less intense, changes in the middle part of the vastus intermedius muscle and in several of the muscles in the posterior and lateral thigh.
Subcutaneous edema and perifascial fluid accumulation around the anterior and lateral compartment.
Left: Normal appearance of osseous and soft tissue structures.
In view of the clinical picture, the findings are most consistent with diabetic myonecrosis.
Case Discussion
Painful muscle swelling in a patient with poorly controlled diabetes mellitus should raise suspicion for diabetic myonecrosis.
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