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Chernyadyev SA, Ufimtseva MA, Vishnevskaya IF, Bochkarev YM, Ushakov AA, Beresneva TA, Galimzyanov FV, Khodakov VV. Fournier's Gangrene: Literature Review and Clinical Cases. Urol Int 2018; 101:91-97. [PMID: 29949811 PMCID: PMC6106138 DOI: 10.1159/000490108] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/03/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fornier gangrene is an extremely rare disease of the genitals. This disease is a result of the urogenital tract, anorectal area, and genital skin infections, appearing usually in immunocompromised patients with diabetes, obesity, and malignant neoplasms. The basic treatment of Fournier gangrene includes an emergency surgical intervention combined with antibiotic therapy and detoxification. METHODS A review of recent papers comprising studies and reviews published in 2005-2016 was performed. The clinical cases were studied at the Department of Purulent Surgery Central Clinical Hospital No. 1, where 7 patients were diagnosed and treated. RESULTS The etiology, pathogenesis, clinical and laboratory presentation, diagnosis, treatment, and prognosis of Fournier gangrene are described in this article. The authors have described several clinical cases of patients with Fournier gangrene and with necrotic cellulitis and fasciomyositis of anterior abdominal wall, which is a manifestation of Fournier gangrene. Making allowance for the unfavorable epidemiological situation of syphilis in Russia, the increase in the incidence of complicated, atypical chancre, and therefore, the need for differentiation of Fournier gangrene with such manifestations of syphilis as necrotizing, esthiomenous chancre, indurative edema, the appropriate clinical examples are well explained in this article.
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Wang J, Jiao J, Zhao G, Shi J, Xia J. Case report: A rare case of focal myositis presenting as Sartorius muscle contracture: A case report and review of literature. Medicine (Baltimore) 2018; 97:e10766. [PMID: 29768366 PMCID: PMC5976314 DOI: 10.1097/md.0000000000010766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
RATIONALE Focal myositis (FM) is a very rare myopathy of unknown etiology characterized by focal enlargement within one single skeletal muscle. In particular, it occurs only involving the Sartorius muscle has never been reported. PATIENT CONCERNS A 25-year-old man was admitted to the hospital with progressive restricted left hip joint extension, left thigh discomfort and gait disturbance for 6 years. DIAGNOSES Combining clinical manifestations with results of radiological and pathological examinations, it was consistent with the diagnosis of FM INTERVENTIONS:: The patient received a surgery under general anesthesia to release the contracted Sartorius tendon. OUTCOMES The range of motion of the patient's left hip and ipsilateral knee has significantly improved as well as the discomfort of his left thigh relieved obviously after the surgery. LESSONS This case report is the first to report FM presenting as sartorius muscle contracture and the surgery is an alternative therapy for these patients.
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Colombo JR, Dagher W, Wein RO. Benign proliferative myositis of the sternohyoid muscle: review and case report. Am J Otolaryngol 2015; 36:87-9. [PMID: 25239869 DOI: 10.1016/j.amjoto.2014.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 08/26/2014] [Indexed: 12/14/2022]
Abstract
We report a case of a 51-year-old woman who presented with a rapidly enlarging, painful, midline neck mass that developed over a three day period. A CT scan of the neck showed a solid circumscribed mass in the sternohyoid muscle. The initial differential diagnosis included inflammation of thyroglossal duct remnant, an abnormal lymph node, and thyroid carcinoma. The patient underwent operative excision with final pathology revealing proliferative myositis. Proliferative myositis is an uncommon benign proliferation of skeletal muscle and has only been reported a limited number of times in the head and neck region.
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Affiliation(s)
- Joshua R Colombo
- Department of Otolaryngology-Head & Neck Surgery, Tufts Medical Center, Boston, MA.
| | - Walid Dagher
- Department of Otolaryngology-Head & Neck Surgery, Tufts Medical Center, Boston, MA
| | - Richard O Wein
- Department of Otolaryngology-Head & Neck Surgery, Tufts Medical Center, Boston, MA
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Malhotra KP, Husain N, Shukla S, Jain P, Sonkar AA. Pseudosarcomatous proliferative myositis of the sternocleidomastoid: a case report. Diagn Cytopathol 2014; 42:1096-8. [PMID: 24578323 DOI: 10.1002/dc.23134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 02/16/2014] [Indexed: 12/30/2022]
Affiliation(s)
- Kiran Preet Malhotra
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Gomti Nagar, Lucknow, Uttar Pradesh, India
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Hayes D, Baker PB, Mansour HM, Peeples ME, Nicol KK. Interstitial lung disease in a child with antisynthetase syndrome. Lung 2013; 191:441-3. [PMID: 23652349 DOI: 10.1007/s00408-013-9468-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 04/13/2013] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Antisynthetase Syndrome is associated with interstitial lung disease in adult patients, but this has not been described in children. MATERIALS AND METHODS A 13-year-old with interstitial lung disease due to Antisynthetase Syndrome and pulmonary arterial hypertension underwent emergent bilateral lung transplantation after a rapid clinical decline. CONCLUSION We present the clinical, radiographic, and histological findings of a child with interstitial lung disease due to Antisynthetase Syndrome.
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Affiliation(s)
- Don Hayes
- Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
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Bass A, Storck C. [CME-ORL 7. Lump of uncertain origin in the left side of the neck in status after sarcoma of the endometrium. Proliferative myositis]. Praxis (Bern 1994) 2013; 102:119-121. [PMID: 23384959 DOI: 10.1024/1661-8157/a001159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Sopena Bert E, Cortiella Masdeu A, Qanneta R, Moltó Llarena E. [Soft tissue infection by probable community-acquired methicillin-resistant Staphylococcus aureus]. Rev Argent Microbiol 2013; 45:61. [PMID: 23560792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
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Salvador FB, Isenberg DA. Use of autologous stem cell transplantation in adult patients with idiopathic inflammatory myopathies: a case-report and review of the literature. Clin Exp Rheumatol 2012; 30:979. [PMID: 23043894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Accepted: 04/19/2012] [Indexed: 06/01/2023]
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Lo SS, Mittal A, Stewart I. Group A streptococcal toxic shock syndrome from a traumatic myositis. N Z Med J 2010; 123:65-67. [PMID: 20657633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Yiğit H, Turgut AT, Koşar P, Astarci HM, Koşar U. Proliferative myositis presenting with a checkerboard-like pattern on CT. Diagn Interv Radiol 2009; 15:139-142. [PMID: 19517385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Proliferative myositis is a rare pseudosarcomatous inflammatory process. Radiological diagnosis of self-limiting proliferative myositis helps direct appropriate clinical management and avoiding unnecessary surgical excision. We present the ultrasonography, computed tomography, and magnetic resonance imaging findings in a case of proliferative myositis. In this case, malignancy was suspected, and complete excision was performed. A checkerboard-like pattern, a characteristic sonographic and pathological finding of proliferative myositis, was demonstrated by computed tomography in our patient; to the best of our knowledge, this is the first such case in the literature.
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Affiliation(s)
- Hasan Yiğit
- Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey.
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Pappalardo S, Pollicino A, Cantalupo Milazzo D, Brutto D, Carlino V, Astuto M. Phlegmon of the face and neck: a case report. Minerva Stomatol 2009; 58:233-245. [PMID: 19436253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Deep face and neck infections are potentially life threatening if they are not diagnosed in time and then treated quickly. This report describes a case of face and deep neck infection, associated with a semi-impacted and decayed wisdom tooth in a cardiopathic, immunosuppressed patient suffering from, diabetes, hypothyroidism, osteoporosis, breathlessness, chronic bronchitis, with oral, cutaneous and vaginal erythematous lichen, Cushing's Syndrome, penicillin allergy, subjected to past hypophysectomy. The swelling was, first of all, treated in urgency, with an intravenous antibiotic therapy and, immediately afterwards, the phlegmonous infiltration linked to the avulsion of the lower third molar was surgically drained. The patient was then treated with intravenous multiple antibiotics, with the aim of eradicating the predominating bacteria that was encountered in the microbiological culture test. A complete remission of the pathological picture was obtained .
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Affiliation(s)
- S Pappalardo
- Department of Medical-Surgical Specialties, Policlinic Hospital ''Gaspare Rodolico'' Catania, University of Catania, Italy.
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Cunningham C, Kohli H, Engelage E. Limb salvaging treatment in a rare case of spontaneous necrotizing myositis. Am Surg 2009; 75:436-438. [PMID: 19445301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Daher EF, Lima RSA, Silva Júnior GB, Almeida JPC, Siqueira FJWS, Santos SQ, Silva SW, Libório AB. Acute kidney injury due to rhabdomyolysis-associated gangrenous myositis. Acta Biomed 2008; 79:246-250. [PMID: 19260387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Rhabdomyolysis is associated with infectious diseases in approximately 5% of cases and acute kidney injury occurs in 33-50% of cases. Gangrenous myositis is a deep seated infection of the subcutaneous and muscular tissues. We report the case of an 18 year-old man who was admitted to the emergency room with leg pain, fever, nausea, vomiting and oliguria. Physical examination showed moderate dehydration, peripheral cyanosis and skin necrosis with severe myalgia and no subcutaneous gas. Laboratory findings at admission were: serum urea 111 mg/dL, creatinine 1.3 mg/dL, potassium 6.3 mEq/L, creatine kinase (CK) 112,452 IU/L, aspartate amino transaminase (AST) 1116 IU/L, alanine amino transaminase (ALT) 1841 IU/L, pH 7.31, bicarbonate (HCO3) 11 mEq/L and lactate 4.3 mmol/L. Emergency hemodyalisis was started, and antibiotics were given due to high suspicion for bacterial infection. The patient developed respiratory insufficiency and septic shock needing mechanical ventilation and vasoactive drugs. He presented spontaneous gangrenous myositis in both legs and in his left arm. After 26 sessions of hemodialysis, partial recovery of renal function was observed. He was discharged from the ICU after 38 days, still with leg pain. Acute kidney injury due to rhabdomyolysis should be considered as a possible complication of gangrenous myositis.
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Affiliation(s)
- Elizabeth F Daher
- Department of Internal Medicine, Division of Nephrology, Faculdade de Medicina, Hospital Universitário Walter Cantidio, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil.
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Oldenburg B. [Myositis as the first manifestation of an exacerbation of Crohn's disease]. Ned Tijdschr Geneeskd 2007; 151:2071. [PMID: 17929719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Affiliation(s)
- O P Gautschi
- Department of Orthopaedic and Trauma Surgery, Royal Perth Hospital, Perth, WA, Australia.
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Berger P, Wolf R, Flierman A, den Dunnen WFA, Hoekstra HJ. [Myositis as the first manifestation of an exacerbation of Crohn's disease]. Ned Tijdschr Geneeskd 2007; 151:1295-8. [PMID: 17624161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
A 19-year-old man presented with general malaise and a swelling in the right hip region and right thigh. The CT images were interpreted as an abscess of the thigh, but surgical exploration revealed a diffuse myositis, with panniculitis, necrosis and inflammation of muscle tissue, associated with an exacerbation of Crohn's disease. The disease responded well to pharmacotherapy, but later an enterocutaneous fistula developed in the direction of the hip, caused by Crohn colitis in the pelvic area, for which resection of the small intestine was carried out followed by a primary anastomosis. The primary treatment of myositis associated with inflammatory bowel disease is medicinal. Being alert to this very uncommon association may prevent unnecessary surgical intervention.
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Affiliation(s)
- P Berger
- Universitair Medisch Centrum Groningen, Postbus 300,001, 9700 RB Groningen.
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DeSouza R, Shapiro A, Westney OL. Adductor brevis myositis following transobturator tape procedure: a case report and review of the literature. Int Urogynecol J 2007; 18:817-20. [PMID: 17577593 DOI: 10.1007/s00192-006-0220-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Accepted: 08/21/2006] [Indexed: 10/23/2022]
Abstract
The tension-free vaginal tape (TVT) procedure has long been considered the gold standard for female stress incontinence. Since its introduction in 1995, several other tapes and other minimally invasive treatments have arisen. The transobturator tape (TOT) procedure reproduces the natural suspension of the urethra through the obturator and puborectalis muscles. The TOT procedure was reportedly developed in an effort to prevent bladder perforation associated with the TVT and is generally considered to be a procedure with low morbidity. At our institution, we report the first case of infected mesh with subsequent myositis of adductor muscles after a TOT procedure. To our knowledge, this is the first case reporting this complication, citing specifically that the anatomical structures traversed by the tape, including both muscle and fascia, can be at risk for infection and ultimately require removal of the sling material. We performed a MEDLINE literature search using key words such as "transobturator tape," "tension free vaginal tape," and "adductor and obturator complications" to ascertain any reported adductor or obturator muscle complications after placement of TOT. Further, we reviewed the literature to elucidate the consequences of using different mesh materials, specifically their effects on erosion. We reported our case of a 43-year-old woman who presented with right-leg cellulitis and vaginal discharge after having a TOT placed for stress incontinence. Inflammation of the adductor muscles was demonstrated on computed tomography (CT) scan and ultrasound. On physical exam, the mesh had visibly eroded through the vaginal wall. Our patient underwent excision of the mesh material. She ultimately had an uneventful postoperative course and was discharged home in good condition on the postoperative day 2. The mesh material removed was ObTape. We believe our study is the first case report to discuss the complication of infected adductor muscles and erosion of the tape during post-TOT procedure. After a careful review of the literature, there is no mention of myositis of adductor muscles as a possible complication after the TOT procedure. In fact, the literature has deemed this minimally invasive treatment as a safe and effective procedure with minimal complications including only de novo urgency or urinary retention. The site of infection is of particular interest and can be explained by the course through the anatomical structures that are unique to this particular procedure. Ultimately, the treatment for this procedure was the removal of the mesh along with broad-spectrum antibiotics. In conclusion, the burden falls upon the surgeons to report in a timely fashion both successes and complication for the TOT procedure given their relatively limited experience. This is paramount in determining patients' risks.
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Affiliation(s)
- Rowena DeSouza
- Division of Urology, The University of Texas Health Science Center at Houston, 6431 Fannin St., Suite 6.018, Houston, TX 77030, USA.
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Abstract
Necrotising myositis is a surgical emergency. It is underappreciated that it may present without changes in the skin. Diagnosis is therefore often delayed. We describe a case of necrotising myositis necessitating glenohumeral disarticulation. Remarkable features were the absence of skin signs and the rapidity with which the patient became extremely septic. A review of the literature has shown the importance of early diagnosis and quick decision making to minimise mortality.
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Affiliation(s)
- G H Smith
- Department of Orthopaedics, Royal Infirmary Edinburgh, UK.
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Mardi K, Sharma J. Focal eosinophilic myositis--a rare cause of pseudotumor. INDIAN J PATHOL MICR 2006; 49:390-1. [PMID: 17001893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
Idiopathic focal eosinophilic myositis is a rare benign pseudotumor of skeletal muscle of unknown cause, characterized by focal eosinophilic infiltration of striated muscle. It can mimic a soft tissue sarcoma clinically and on gross examination of the specimen. Microscopic examination establishes the diagnosis. It is important to recognize this pseudosarcomatous lesion so as to spare the patient from anxiety.
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Affiliation(s)
- Kavita Mardi
- Department of Pathology, Indira Gandhi Medical College, Shimla.
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Yamada K, Wasa J, Sugiura H, Horio Y. [A case of multiple pyomyositis after chemotherapy for lung cancer]. Gan To Kagaku Ryoho 2006; 33:837-40. [PMID: 16770109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
We here describe a case of multiple pyomyositis in a 62-year-old man who had systemic chemotherapy for recurrent lung cancer. His initial symptoms consisted of fever and general fatigue, followed by progressive pain and swelling in his extremities, which mimicked deep venous thrombosis along with bacterial infection. He was admitted to the hospital for intravenous administration of antibiotics. MRI appeared very useful to find the intramuscular fluid collections with circumferential inflammatory changes, which confirmed diagnosis of the multiple pyomyositis. Surgical drainage as well as intravenous administration of antibiotics worked very well and improved clinical symptoms in a few weeks after the treatments. He could resume normal activities with minimum functional impairments in the extremities. Pyomyositis should be kept in mind as one of the adverse effects after chemotherapy for malignant tumors.
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Affiliation(s)
- Kenji Yamada
- Dept. of Orthopedic Surgery, Aichi Cancer Center Hospital
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Abstract
This article describes a rare case of a myositis of the sternocleidomastoid muscle due to an acute septic arthritis of the sternoclavicular joint. A 51-year-old male in reduced condition was admitted to the Department of Otorhinolaryngology with a one-week history of a painless swelling of the sternocleidomastoid muscle associated with recurrent fever. Physical examination was otherwise unremarkable. An intravenous antibiotic therapy was initiated without improvement of the process, accordingly a specific infection or a malignancy was ruled out by biopsy. The positron emission tomography and magnetic resonance imaging finally revealed the diagnosis of a septic arthritis of the sternoclavicular joint as the causal focus of the infection. After an extensive surgical debridement and under continued antibiotic therapy the patient made an uneventful recovery. The acute septic arthritis of the sternoclavicular joint is an uncommon infection with an insidious onset and is often unrecognized until it spreads to adjacent structures leading to serious complications. This case emphasizes that a myositis of sternocleidomastoid muscle can be caused by an ascending infection due to an acute septic arthritis of the sternoclavicular joint. Clinical course, diagnosis and treatment of this uncommon disease are reviewed in this article.
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Affiliation(s)
- A Park
- Universitäts-Hals-Nasen-Ohren-Klinik, Universität Duisberg-Essen, Hufelandstrasse 55, 45122 Essen
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Jayawickrama MMA, Jayasekara HRRG, de Silva MVC. Proliferating myositis and proliferating fasciitis: benign lesions often misdiagnosed as sarcomas. Ceylon Med J 2006; 50:169-70. [PMID: 16538915 DOI: 10.4038/cmj.v50i4.1412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Schmidt K, Büter M, Bussen D, Thiede A. [The non-tropical pyomyositis--a rare disease in the moderate climate zone]. Zentralbl Chir 2005; 130:589-93. [PMID: 16382410 DOI: 10.1055/s-2005-918159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Pyomyositis is in the moderate climate zone a rare and acute bacterial infection of the skeletal muscles without an obvious origin of infection. Initial symptoms contain muscle pain and localized swelling and tension. As different causes are taken into account first, the diagnosis of a pyomyositis is often delayed. We report on three cases of pyomyositis and discuss diagnosis and therapy against the background of the available and recent literature.
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Affiliation(s)
- K Schmidt
- Klinikum der Julius-Maximilians-Universität Würzburg, Zentrum Operative Medizin, Chirurgische Klinik I und II, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany.
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Yu CW, Hsiao JK, Hsiao JK, Hsu CY, Shih TTF. Bacterial pyomyositis: MRI and clinical correlation. Magn Reson Imaging 2005; 22:1233-41. [PMID: 15607094 DOI: 10.1016/j.mri.2004.08.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2004] [Accepted: 08/01/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To characterize the findings of magnetic resonance imaging (MRI) of bacterial pyomyositis (PM) and correlate these data with the clinical information. MATERIALS AND METHODS Eighty-one patients were diagnosed with PM in our institute between 1997 and 2003. Of these, 40 patients (21 male, 19 female; mean age, 53 years) also underwent MRI examination. The clinical manifestation underlying medical problems and the characteristics of MRI were analyzed. Thirty of the patients received surgical intervention or image-guided drainage/aspiration of the abscess along with administration of antibiotics, while the remaining 10 patients were promptly treated solely with antibiotics. RESULTS Thirty-one of 40 patients had underlying medical problems. These involved diabetes mellitus (DM, n = 16), malignancies including cervical cancer, prostate cancer, non-Hodgkin's lymphoma and acute lymphocytic leukemia (n = 10, one case also had DM), autoimmune disease or asthma with long-term steroid usage (n = 4, one case also had DM), liver cirrhosis (n = 2) and chronic renal insufficiency (n = 1). Four patients had no abscess formation at presentation (invasive or early purulent stage), while the remaining 36 cases presented with at least one abscess (purulent stage). Patients older than 40 years or DM patients tended to have larger abscess(s) (P < .05). Gadolinium-enhanced images demonstrated either thick (n = 12) or thin rim enhancement (n = 24) of the abscess wall. For those 10 patients promptly treated solely with antibiotics, nine demonstrated thin rim enhancement of the abscess (P < .05). CONCLUSION Magnetic resonance imaging plays an important role in the early recognition of bacterial PM. By precisely demarcating the extent of the disease, MRI can allow planning prompt antibiotic treatment combined with or without interventional procedures.
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Affiliation(s)
- Chih-Wei Yu
- Department of Medical Imaging, Medical College and Hospital, National Taiwan University, Taipei, Taiwan, 100
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Vasile I, Vîlcea D, Persu B, Nemeş R, Cheie M, Calotă F, Paşalega M, Meşină C, Curcă T, Traşcă E, Scurtu S. [Severe nosocomial infection of soft tissue in general surgery]. Chirurgia (Bucur) 2005; 100:281-6. [PMID: 16106937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This paper aim is to emphasize the severity of soft tissue nosocomial infections, determined by anaerobic bacteria associated with Gram-negative aerobic bacteria: 50% mortality, higher economic costs, disabling morphologic and functional sequels. We present the pathogenic, clinical and therapeutically problems which characterize this type of postoperative infections.
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Affiliation(s)
- I Vasile
- Clinica Chirurgie II, UMF Craiova.
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Jaras Hernández MJ, González Polo J, Gómez Lumbreras A, Sánchez Garrido R, Gordo Mejías A, Noguerado Asensio A. [Pyomyositis in diabetic patient]. An Med Interna 2005; 22:254-5. [PMID: 16089019 DOI: 10.4321/s0212-71992005000500019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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Kuczkowski J, Narozny W, Stankiewicz C, Mikaszewski B, Izycka-Swieszewska E. Zygomatic abscess with temporal myositis - a rare extracranial complication of acute otitis media. Int J Pediatr Otorhinolaryngol 2005; 69:555-9. [PMID: 15763297 DOI: 10.1016/j.ijporl.2004.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2004] [Revised: 10/13/2004] [Accepted: 10/16/2004] [Indexed: 11/22/2022]
Abstract
Acute mastoiditis is the most common complication of acute otitis media (AOM) and its early recognition and management still poses a challenge due to potentially serious consequences. The incidences of extracranial and intracranial suppurative complications of AOM in children have decreased significantly, yet they remain a serious clinical problem, especially when caused by bacteria resistant to antibiotics. The authors presented a case of rare AOM complication - zygomatic abscess with temporal myositis. A 6-year-old boy was admitted to the ENT Department with 4 weeks of ear pain, treated for AOM with cefuroxime axetyl and amoxicilline, with acute mastoiditis and subsequent abscess formation in zygomatic and preauricular region. The inflammatory process spread through anterior air cells to the zygomatic cells leading to a fistula formation in the zygomatic bone and breakthrough into the temporal muscle. The surgical procedures applied were: myringotomy with drainage, cortical mastoidectomy and revision of zygomatic area and treatment with antibiotics (ceftriaxon). Enterococcus faecalis and Streptococcus viridans were found in the culture of middle ear and mastoid effusion. After half a year of follow-up the child had a normal hearing. Severe complications of AOM are rare today. An early diagnosis in order to promote adequate management and prevent inherently suppurative complications is essential.
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Affiliation(s)
- Jerzy Kuczkowski
- Department of Otolaryngology, Medical University of Gdańsk, Poland ul. Debinki 7, Building 16, 80-211 Gdańsk, Poland.
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28
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Abstract
BACKGROUND The main objective of our work was to draw attention to the possible occurrence of a serious and life-threatening illness, primary pyomyositis of the obturator muscles in countries with a mild climate, and to establish basic diagnostic criteria for the illness, including differential diagnostics, and to propose a treatment method. METHODS The authors describe two cases (a boy of 11 and a woman aged 47 years) with the occurrence of primary pyomyositis of the obturator muscles in the Czech Republic and they focus on the most important clinical symptoms and imaging methods necessary for the establishment of the diagnosis. RESULTS Repeated clinical examinations are important for the establishment of the diagnosis, particularly the presence of the symptom triad (pain in the hip joint, limping, febrile state), positive inflammatory markers and, first and foremost, the demonstration of pyomyositis on CT or MR. Differential diagnosis must also consider inflammatory diseases of the locomotor system (coxitis, sacroiliitis, osteomyelitis), of the digestive tract (Crohn's disease, a tumour, an obturator hernia) and of the urogenital system (gonorrhoea). CONCLUSION The therapy of pyomyositis must be initiated in time by bed rest and administration of antibiotics and, if an abscess develops, surgical intervention is unconditionally necessary, consisting either in percutaneous abscess puncture or incision, perfusion, and application of antibiotics. The failure to diagnose an abscess of the obturator muscles and late therapy can result in serious complications, septic shock and death.
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Affiliation(s)
- K Koudela
- Klinik für Orthopädie und Traumatologie des Bewegungsapparates, Chirurgische Klinik, Medizinische Fakultät der Karls-Universität und Universitätskrankenhaus Pilzen.
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29
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Glushchenkov VA, Alekseeva EA, Sivirinov II, Kiselëva LM, Feodoridi LA. [Certain aspects of the present-day diagnosis and treatment of iliopsoitis]. Vestn Khir Im I I Grek 2005; 164:83-4. [PMID: 15957818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
MR-tomography is known to be a valuable method of investigation. It allows to get a picture of thin layers of the human body in any section. In addition, it facilitates the diagnosis of inflammatory alterations to the muscles of the retroperitoneal space before the development of purulent phases of inflammation. The difficulties of the diagnosis of pyo-inflammatory diseases are leveled due to practical possibility of MRT to detect the inflammation focus.
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30
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Abstract
Mycotic aneurysms of the coronary arteries are extremely rare, with 15 cases reported. We report the successful treatment of a mycotic aneurysm of the left anterior descending coronary artery by coronary artery bypass grafting with aneurysm ligation and resection without the use of cardiopulmonary bypass.
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Affiliation(s)
- Jerry W Pratt
- Keesler Medical Center, Keesler Air Force Base, Biloxi, Mississippi, USA
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31
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Abstract
STUDY DESIGN A case of necrotizing soft tissue infection in a patient with spinal cord injury with extension of infection into the spinal canal and spinal cord is presented. OBJECTIVE To review the history, risk factors, pathophysiology, diagnosis, treatment, and morbidity and mortality regarding necrotizing soft tissue infection as they relate to spinal cord injury. SUMMARY OF BACKGROUND DATA Necrotizing soft tissue infection related to decubitus ulcers is rare. To our knowledge, this is the first report of this disease related to a sacral decubitus ulcer with extension of the necrotizing infection into the spinal canal. METHODS The clinical, radiographic, and pathologic features associated with necrotizing soft tissue infection are presented. The patient presented with a late-stage necrotizing soft tissue infection requiring extensive de-bridement of necrotic tissue, which the patient underwent on admission. RESULTS The patent died of refractory septic shock and multiple-organ failure after surgery. CONCLUSION Necrotizing soft tissue infections from decubitus ulcers are rare and unpredictable, and ultimately have a progressively aggressive course. The case reported herein is the first report of necrotizing soft tissue infection from a decubitus ulcer in a patient with spinal cord injury with extension into the spinal canal and spinal cord.
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Affiliation(s)
- Steven C Cunningham
- Department of Surgery, Veterans Affairs Maryland Healthcare System, Baltimore, MD, USA
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32
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Ferrari D, Bertoni F, Bacchini P, Donzelli O. Focal myositis. Description of a case and review of the literature. Chir Organi Mov 2004; 89:75-9. [PMID: 15382589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
The authors describe a rare form of pseudotumor of the muscle tissue of an inflammatory nature with an unknown etiology that occurred in a boy aged 13 years, characterized by the occurrence of rapidly-developing swelling, no pain symptoms, with degeneration of the myofibers, evident eosinophilia and lymphomonoplasmacellular infiltrate. Surgical excision of the lesion is the treatment of choice.
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Affiliation(s)
- D Ferrari
- Divisione di Ortopedia e Traumatologia Pediatrica, Istituto Ortopedico Rizzoli, Bologna
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33
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Nichol P, Rod R, Corliss RF, Schurr M. Central myonecrosis in a patient with group a beta-hemolytic streptococcus toxic shock syndrome. J Trauma 2003; 55:994-6. [PMID: 14608183 DOI: 10.1097/01.ta.0000027129.46348.7c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- Peter Nichol
- Department of Surgery, University of Wisconsin Hospital, 600 Highland Avenue, Madison, WI 53792, USA
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34
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Affiliation(s)
- Sam Sami
- Orthopedic Oncology Service, Massachusetts General Hospital, Boston, Mass 02114, USA
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35
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Lam R, Lin PH, Alankar S, Yao Q, Bush RL, Chen C, Lumsden AB. Acute limb ischemia secondary to myositis-induced compartment syndrome in a patient with human immunodeficiency virus infection. J Vasc Surg 2003; 37:1103-5. [PMID: 12756362 DOI: 10.1067/mva.2003.179] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Myositis, while uncommon, develops more frequently in patients with human immunodeficiency virus infection. We report a case of acute lower leg ischemia caused by myositis in such a patient. Urgent four-compartment fasciotomy of the lower leg was performed, which decompressed the compartmental hypertension and reversed the arterial ischemia. This case underscores the importance of recognizing compartment syndrome as a cause of acute limb ischemia.
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Affiliation(s)
- Russell Lam
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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36
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Tachi M, Hirabayashi S, Harada H, Nishio T. Pathophysiology and treatment of streptococcal toxic shock syndrome. Scand J Plast Reconstr Surg Hand Surg 2003; 36:305-8. [PMID: 12477090 DOI: 10.1080/028443102320791860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We have recently encountered three cases of streptococcal toxic shock syndrome, each of which had a different cause. All the patients had inflammation of soft tissue in the lower extremities, and developed shock and multiple organ failure immediately after the clinical visit. The inflammation of soft tissue was necrotising fasciitis in one case, myositis in one case, and phlegmon in one. In the first case the debridement was incomplete, which resulted in an extensive ulceration. Wary of repeating this experience, we made an early diagnosis and did a thorough debridement in the second case. The patient was ultimately discharged without complications. It is rare that a patient with extensive myositis survives without amputation of the extremity. The third patient responded well to early treatment with antibiotics.
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Affiliation(s)
- Masahiro Tachi
- Departments of 'Plastic and Reconstructive Surgery, Teikyo University School of Medicine, St Luke's International Hospital, Tokyo, Japan.
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37
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Nagelvoort RWK, Hulstaert PF, Kon M, Schuurman AH. [Necrotising fasciitis and myositis as serious complications after liposuction]. Ned Tijdschr Geneeskd 2002; 146:2430-5. [PMID: 12518522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Three days after liposuction of the lower abdomen, a 41-year-old woman was admitted for toxic shock-like syndrome with necrotising fasciitis and myositis, caused by Lancefield-group-A beta-haemolytic streptococci. The patient was treated by radical debridement of the skin, subcutis, fasciae and part of the pectoral muscle, plus antibiotics. Postoperatively she required artificial respiration for respiratory insufficiency. One week after the operation the wound was covered by transplantation of autologous skin. The patient survived, but was seriously disfigured. Necrotising fasciitis is a progressive soft-tissue infection, characterised by widespread necrosis of the superficial and deep fascia, often associated with severe systemic toxic reactions. Unless quickly recognised and aggressively treated, the course is often fatal. Due to the absence of cutaneous findings in the early stages, diagnosis is difficult. Important diagnostic aids are routine laboratory tests, contrast-MRI and a combination of the finger test and frozen-section biopsy. Treatment consists of early radical debridement, broad-spectrum antibiotics and supportive care. In a later stage, soft-tissue reconstruction with autografts or artificial skin grafts and skin transposition can be performed.
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Affiliation(s)
- R W Klein Nagelvoort
- Afd. Plastische, Reconstructieve en Handchirurgie, Universitair Medisch Centrum, Heidelberglaan 100, 3584 CX Utrecht
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38
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Möckl C, Kotter A, Mayr E, Wagner T, Rüter A. [Focal myositis--an indication for surgery? A case report]. Chirurg 2002; 73:1063-6. [PMID: 12395167 DOI: 10.1007/s00104-002-0508-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This case report describes focal myositis, a rare inflammatory pseudotumorous disease previously not mentioned in the surgical literature. Most often a single muscle of the upper or lower extremity is affected. Usually the diagnostic process and treatment require a long time. We present a useful diagnostic cascade and a surgical therapy, which allows the histological differentiation between malignant and inflammatory disease. Even after partial resection of the tumor, the prognosis of focal myositis is excellent.
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Affiliation(s)
- C Möckl
- Klinik für Unfall- und Wiederherstellungschirurgie, Klinikum Augsburg, Germany
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39
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Affiliation(s)
- Gerald Wolf
- Division of Nuclear Medicine, Department of Radiology, Karl-Franzens-University Graz, Graz, Austria
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40
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Llauger J, Bagué S, Palmer J, Matías-Guiu X, San Román L, Doncel A. Focal myositis of the thigh: unusual MR pattern. Skeletal Radiol 2002; 31:307-10. [PMID: 11981609 DOI: 10.1007/s00256-002-0494-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2001] [Revised: 01/18/2002] [Accepted: 02/05/2002] [Indexed: 02/02/2023]
Abstract
Focal myositis is a commonly referenced, infrequently reported and poorly documented benign inflammatory pseudotumor which may be misdiagnosed clinically as a malignant tumor. We report the clinicopathologic features and magnetic resonance imaging findings in a case of focal myositis in the thigh of a 55-year-old woman. A different radiologic presentation of this disorder is described. The gross appearance of the lesion, previously undescribed, appears to be rather specific for such a pseudoneoplastic disorder, and correlates very well with the magnetic resonance imaging features.
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Affiliation(s)
- Jaume Llauger
- Department of Radiology, Hospital de la Santa Creu i Sant Pau, Avgda Sant Antoni M. Claret 167, 08025 Barcelona, Spain.
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41
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Abstract
Myositis proliferans is a rare and benign pseudosarcomatous tumour of soft tissue. In most cases it is found in the region of the shoulder and arm and its occurrence in the region of the neck is described in literature in 16 cases in all. For the ear, nose and throat specialist it is an important differential diagnosis in contrast to malignant tumours. In this report we present the cases of two patients, who were suffering from painful cervical swelling that had been increasing for some days. The problems inherent in the diagnosis of this illness are discussed. Due to its rapid growth the tumour is generally falsely diagnosed and radically removed. Therefore, in appropriate case history, this possibility should be considered and excluded in order to prevent the patient from unnecessary radical operation. In addition to clinical symptoms, imaging and trial excision are suitable.
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Affiliation(s)
- R Budde
- HNO-Klinik der Universität Witten/Herdecke, St.-Marien-Hospital, Hagen
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42
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Abstract
Proliferative myositis is a rare, inflammatory tumor that is often misdiagnosed as sarcoma. The clinical course of proliferative myositis is benign, and local recurrence after simple excision is uncommon. Typically, the lesion presents in the extremities or the head and neck. We present an unusual case of proliferative myositis with involvement of the anterior chest wall.
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Affiliation(s)
- Michael S Kent
- Department of Cardiothoracic Surgery, The New York-Presbyterian Hospital, Weill-Cornell Medical Center, New York 10021, USA
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43
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Abstract
Group A beta-hemolytic Streptococcus pyomyositis continues to be an uncommon disease. We present a case of a 7-year-old boy with an M protein type 1, streptococcal pyrogenic exotoxin A and B, Streptococcus pyogenes pyomyositis and streptococcal toxic shock syndrome.
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Affiliation(s)
- Sophia J Zervas
- Department of Pediatrics, University of Connecticut School of Medicine, Hartford, CT, USA
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44
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Affiliation(s)
- W M Tang
- Department of Orthopedic Surgery, Queen Mary Hospital, Hong Kong, China.
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45
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Abstract
From January 1988 to December 1999, 43 adults with pyomyositis were managed at Ahmadu Bello UniversityTeaching Hospital, Zaria, Nigeria. Staphylococcus aureuswas the most commonly cultured organism (92.5%). All the 41 patients responded well to incision and adequate drainage, antibiotics and partial thickness skin grafting in 10 patients (23.2%).Two patients (4.65%) died from septicaemia, while being resuscitated.
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Affiliation(s)
- L M Yusufu
- Department of Surgery, ABU Teaching Hospital, Zaria, Nigeria
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46
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Choe JM, Battino BS, Benedict J, Bell TE. Myositis and myonecrosis of the thigh: an unusual complication of a testicular thigh pouch. J Urol 2001; 165:1217. [PMID: 11257682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- J M Choe
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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47
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Abstract
Pyomyositis, although uncommon, is being reported with greater frequency in temperate climates. The presentation is similar to a number of infectious processes, and when associated with a traumatic event, the clinical picture may be confused with that of a musculoskeletal injury. This, coupled with an unfamiliarity of the disease, may result in a delay in diagnosis. Early antibiotic therapy may obviate surgery. Progression to the suppurative stage requires surgical drainage along with antibiotics. CT guided drainage may be accomplished in certain cases. In immunocompromised patients, progression to the septicemic stage is associated with high morbidity and mortality.
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Affiliation(s)
- C Bibbo
- Department of Orthopaedic Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, USA.
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48
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Rhomberg M, Furtmüller F, Haidinger D, Nopp WH, Rieder-Scharinger J, Schobersberger W, Piza-Katzer H. [Streptococcal toxic shock-like syndrome with necrotizing myositis]. Chirurg 2000; 71:844-7. [PMID: 10986609 DOI: 10.1007/s001040051147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Streptococcal toxic shocklike syndrome is caused by group A streptococci and characterized by multiorgan failure and soft-tissue necrosis, often in young patients with a bland history and at most a minor trauma. Diagnosis is reached through the clinical presentation, imaging methods and positive bacterial verification. The course is fulminant and in the case of muscle involvement, mortality reaches 80-100%. Therapy consists of immediate fasciotomy and often of debridement of affected soft tissues with high-dose antibiotics in intensive care. Sometimes an unconfirmed diagnosis must be sufficient to operate. We report the case of a 29-year-old man without an exceptional history who was forced to undergo thigh amputation, multiple soft-tissue debridements, and after a total of 240 erythrocyte concentrates, finally hip joint enucleation.
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Affiliation(s)
- M Rhomberg
- Universitätsklinik für Plastische und Wiederherstellungschirugie Innsbruck.
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49
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Abstract
Pyomyositis is an uncommon infection in temperate climates, however, it is being more frequently reported among patients with diabetes or malignancy, or those who are immunocompromised. It is predominantly caused by Staphylococcus aureus, and rarely by Bacteroides species. Pyomyositis due to Prevotella melaninogenica has not previously been reported. We describe an elderly patient with pyomyositis of the thigh due to P. melaninogenica which was successfully treated by surgical incision and drainage in combination with metronidazole therapy.
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Affiliation(s)
- M Odeh
- Dept. of Internal Medicine B, Bnai Zion Medical Center, Haifa, Israel
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50
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Abstract
In a 10-year period, 31 children with 35 pyomyositis were managed in Zaria, northern Nigeria. Twenty-two (71%) were less than 10 years of age, with a peak incidence at between 5 and 9 years. The leg muscles, mainly the quadriceps, were most frequently involved (51.4%), followed by the trunk muscles (25.7%), predominantly those of the anterior abdominal wall. Arm and shoulder girdle muscles were less frequently affected (11.4% each). Staphylococcus aureus was the most frequently cultured organism (75%) and was usually sensitive to cloxacillin and, to a lesser degree, to erythromycin and chloramphenicol. Incision and adequate drainage was usually very effective with recurrence at only one site. Antibiotics were used routinely. Involvement of the heart and lungs occurred in two children respectively, the former causing the only death. The average duration of hospital stay was 20 days.
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Affiliation(s)
- E A Ameh
- Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
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