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Ukon Y, Tanaka T, Nagata S, Hagizawa H, Imura Y, Tamiya H, Oshima K, Naka N, Aoki Y, Kuratsu S. Calcific myonecrosis mimicking soft tissue sarcoma: A case report. Oncol Lett 2018; 15:7909-7913. [PMID: 29731908 PMCID: PMC5920900 DOI: 10.3892/ol.2018.8320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 02/28/2018] [Indexed: 12/26/2022] Open
Abstract
Calcific myonecrosis is a rare soft tissue condition. The first case was reported in 1960, however, the precise pathophysiology of calcific myonecrosis remains unclear. The disease was thought to arise from compartment syndrome within a confined space resulting in necrosis and fibrosis, subsequent repeated intralesional hemorrhage, mass enlargement and calcification. Several previous reports have described calcific myonecrosis, which include the formation of calcific myonecrosis after a prolonged period of post trauma. Notably, calcific myonecrosis has typically been described in the lower legs and characteristic imaging findings have been indicated. Furthermore, surgical intervention carries a high risk of complications. In the present case report 2 cases of calcific myonecrosis that occurred after a prolonged period of time following a traumatic event that impacted the lower leg were reported. CT images revealed disruption of calcified fascia and disease expansion into the outside of the fascia. Previous reports have implied that there is late focal enlargement of calcific myonecrosis following earlier enlargement, which may be caused by herniation through muscle fascia. However, no previous publications have focused on images for evidence of late local enlargement. To the best of our knowledge, this is the first report focusing on fascial herniation of calcific myonecrosis using images. Analysis of this feature using images may aid clinicians to differentiate calcific myonecrosis from malignancies.
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Affiliation(s)
- Yuichiro Ukon
- Department of Orthopaedic Surgery, Belland General Hospital, Sakai, Osaka 599-8247, Japan.,Department of Orthopaedic Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Takaaki Tanaka
- Department of Orthopaedic Surgery, Belland General Hospital, Sakai, Osaka 599-8247, Japan.,Department of Orthopaedic Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Shigenori Nagata
- Department of Pathology and Cytology, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Hiroki Hagizawa
- Department of Orthopaedic Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Yoshinori Imura
- Department of Orthopaedic Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Hironari Tamiya
- Department of Orthopaedic Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Kazuya Oshima
- Department of Orthopaedic Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Norifumi Naka
- Department of Orthopaedic Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Yasuaki Aoki
- Department of Orthopaedic Surgery, Japanese Red Cross Society Himeji Hospital, Himeji, Hyogo 670-8540, Japan
| | - Shigeyuki Kuratsu
- Department of Orthopaedic Surgery, Belland General Hospital, Sakai, Osaka 599-8247, Japan
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Abstract
Chronic exertional compartment syndrome (CECS) is a rare condition that usually affects distance runners and other running athletes. It is characterized by pain and pressure in one or multiple muscle compartments with repetitive physical activity. Reduction in pain typically occurs with cessation of activity. Evaluation of CECS consists of a thorough history of patient symptoms and ruling out of other causes of symptoms. Post-exercise pressure measurements can help confirm the diagnosis when symptoms are consistent and imaging evaluation negative for other causes. Non-operative treatment is a viable option for hindfoot runners and patients with anterior compartment syndrome of the leg. Limited-incision fasciotomy has been shown to be the most effective treatment and remains the gold standard for treatment. Minimal-incision open fasciotomy and endoscopic fasciotomy have surgical outcomes similar to wide-open fasciotomy. Military patients treated with fasciotomy have higher failure rates compared to civilians. Pediatric patients have similar outcomes compared to adults.
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Affiliation(s)
- Sravya Vajapey
- a Wexner Medical Center, Orthopaedics , Ohio State University , Columbus , OH , USA
| | - Timothy L Miller
- a Wexner Medical Center, Orthopaedics , Ohio State University , Columbus , OH , USA
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