Calcific Myonecrosis of the Leg: A Rare Entity

Bilateral Lower Extremity Calcific Myonecrosis: A Case Report

Introduction

Calcific myonecrosis is a rare soft-tissue disease where a single muscle or muscle compartment is replaced with central liquefaction and peripheral calcification. This disease usually occurs in a single limb after trauma. Until now, bilateral muscle involvement has not been previously reported.

Case Report

A 73-year-old woman presented with symptomatic masses in the soft tissues of bilateral anterior thighs. She had no known history of trauma but recalled a specific tearing sensation episode in both her legs while squatting when weightlifting in the distant past. The patient had calcified masses that had replaced the rectus femoris muscle bilaterally with associated effects on hip and knee range of motion. The patient underwent excision of a portion of calcific myonecrosis and two locations of rectus femoris tenotomies in one leg and only a simple rectus femoris tenotomy on the contralateral leg. The patient subsequently experienced a significant improvement in hip and knee motion and a reduction in associated pain on both sides.

Conclusion

Historical and radiographic information are key in making the diagnosis of calcific myonecrosis. Treatment decisions should be based on the patient's symptoms balanced with the morbidity of the expected procedures. Symptomatic patients should be considered for excision of the symptomatic involved areas. A tenotomy may be a viable option if a limitation in motion is the primary complaint. Asymptomatic patients with a stable lesion and imaging should undergo conservative management due to the high risk of infection and wound healing problems.

Treatment of infected calcific myonecrosis with chronically discharging sinus caused by iatrogenic aspiration: A case report

Introduction and importance

Calcific myonecrosis (CM) is a rare, benign post-traumatic sequela which is often challenging to differentiate from soft tissue tumors. Infected CM is recalcitrant and sometimes requires invasive treatment despite its benign nature. We present a case of infected CM in which MRI and ²⁰¹Tl scintigraphy proved useful for diagnosis and intralesional debridement with prolonged placement of a suction tube allowed for successful treatment.

Case presentation

A 71-year-old man had undergone repeated aspiration for swelling of the lower leg and presented with a sustained pyogenic discharging wound. He underwent intralesional debridement of purulent necrotic tissue followed by prolonged suction tube placement. Enterobacter cloacae was detected in the discharge, and specific antibiotics were administered. Once the wound closed, a new sinus recurred four months after surgery, warranting reoperation with debridement of the remnant fascia and necrotic tissue with suction tube replacement. The wound healed eight months after the first surgery with no signs of recurrence.

Clinical discussion

CM can be diagnosed based on its unique imaging features and a history of compartment syndrome. To avoid infection, CM must be treated conservatively without surgical invasions, such as biopsy or aspiration. Extensive debridement with a myocutaneous flap is nevertheless recommended for infected CM treatment, despite significant invasion including intraoperative bleeding being problematic.

Conclusion

MRI and ²⁰¹Tl scintigraphy can help diagnose CM and avoid biopsy to exclude malignancy. Intralesional debridement of necrotic tissue with prolonged suction tube placement could be a valid treatment alternative to reduce the invasiveness of infected CM.

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Calcific myonecrosis is a rare, benign posttraumatic sequela.

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Biopsy to differentiate malignancy can cause calcific myonecrosis.

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Absence of accumulation on enhanced MRI or ²⁰¹Tl scintigraphy helped diagnosis.

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Extensive debridement and flaps are reliable but invasive in case of infection.

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Intralesional debridement with prolonged tube placement may be less invasive.

Giant nontraumatic myositis ossificans in a child: A case report

BACKGROUND

Nontraumatic myositis ossificans is a rare disease whose specific pathogenesis is unclear. Early diagnosis of this disease is very difficult in children because of difficulties in determining medical history and nonspecific early clinical manifestations, which may lead to the failure of timely and effective diagnosis and treatment in some patients. We report the diagnosis and treatment of a child with nontraumatic myositis ossificans and summarize the clinical characteristics and diagnosis and treatment of the disease.

CASE SUMMARY

An 8-year-old girl first came to our hospital for more than a week with pain in the right lower limb. There was no history of trauma or strenuous activities. On physical examination, no mass on the right thigh was found, and the movement of the right lower extremity was limited. Ultrasonography showed synovitis of the hip, and bed rest was recommended. Three days later, the child’s pain persisted and worsened, accompanied by fever and other discomforts. She came to our hospital again and a mass was found on the right thigh with redness and swelling on the surface. The images showed a soft tissue tumor on the right thigh with calcification. Routine blood tests revealed that the inflammation index was significantly increased. In case of infection, the patient was given antibiotics, and the pain was relieved soon after, without fever. However, the right thigh mass persisted and hardened. The patient underwent incision biopsy more than 1 mo later, and the postoperative pathology showed nontraumatic myositis ossificans. After approximately 9 mo of observation, the tumor still persisted, which affected the life of the child, and then resection was performed. Since follow-up, there has been no recurrence.

CONCLUSION

Due to the difficulty in discerning a child's medical history and the diverse early manifestations, it is difficult to diagnose nonossifying muscle disease in children in its early stage. Measures such as timely follow-up and periodic image monitoring are conducive to early diagnosis of the disease. The disease has a certain degree of self-limitation, and it can be observed and treated first. If the tumor persists in the later stage or affects functioning, then surgery is considered.

Giant nontraumatic myositis ossificans in a child: A case report

BACKGROUND

Nontraumatic myositis ossificans is a rare disease whose specific pathogenesis is unclear. Early diagnosis of this disease is very difficult in children because of difficulties in determining medical history and nonspecific early clinical manifestations, which may lead to the failure of timely and effective diagnosis and treatment in some patients. We report the diagnosis and treatment of a child with nontraumatic myositis ossificans and summarize the clinical characteristics and diagnosis and treatment of the disease.

CASE SUMMARY

An 8-year-old girl first came to our hospital for more than a week with pain in the right lower limb. There was no history of trauma or strenuous activities. On physical examination, no mass on the right thigh was found, and the movement of the right lower extremity was limited. Ultrasonography showed synovitis of the hip, and bed rest was recommended. Three days later, the child’s pain persisted and worsened, accompanied by fever and other discomforts. She came to our hospital again and a mass was found on the right thigh with redness and swelling on the surface. The images showed a soft tissue tumor on the right thigh with calcification. Routine blood tests revealed that the inflammation index was significantly increased. In case of infection, the patient was given antibiotics, and the pain was relieved soon after, without fever. However, the right thigh mass persisted and hardened. The patient underwent incision biopsy more than 1 mo later, and the postoperative pathology showed nontraumatic myositis ossificans. After approximately 9 mo of observation, the tumor still persisted, which affected the life of the child, and then resection was performed. Since follow-up, there has been no recurrence.

CONCLUSION

Due to the difficulty in discerning a child's medical history and the diverse early manifestations, it is difficult to diagnose nonossifying muscle disease in children in its early stage. Measures such as timely follow-up and periodic image monitoring are conducive to early diagnosis of the disease. The disease has a certain degree of self-limitation, and it can be observed and treated first. If the tumor persists in the later stage or affects functioning, then surgery is considered.