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Myosiis Ossificans
Myosiis Ossificans
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Video Transcription
This is Barry Bellosis, one of the musculoskeletal radiology fellows at Stanford University. 16 year old with two years of right calf pain after calf injury. Concerned for myositis esophagans. The patient in this case presented with this lateral radiograph of tibia and fibula showing dense calcification along the posterior calf. The CT demonstrates the calcification correlating to finding on radiograph demonstrating this curvilinear calcification in the gastrocnemius muscle as seen also on this sagittal imaging. The patient underwent bone scan which demonstrates increased uptake in the right posterior calf. In bone scan there is typically nonspecific increased bone scan uptake on flow and blood pool images in the early development of myositis esophagans and gradually decreases as the lesion matures. This is however not a routine imaging done for patients with myositis esophagans. This is in a different patient with history of trauma approximately six months prior to presentation. On the initial radiograph we can see this ill-defined circumferential calcification projecting over the right posterior calf. On three-month follow-up radiograph we can see that there is gradual formation of calcification predominantly along the periphery. The patient underwent CD without contrast demonstrating a hypodense mass here on our axial imaging centered in the posterior compartment of the calf. There is peripheral calcification correlating to findings seen on prior radiograph. This peripheral calcification is typical of myositis esophagans and gradually forms towards the center. This is also seen here on our coronal imaging. We can see the peripheral distribution of the calcification. In some cases MRI within without contrast are performed on this patient. However, MRI appearances change with the age of the lesion and they're usually non-specific. The early features can be misleading because the peripheral calcification are not usually seen and there could be adjacent edema. In this specific patient, however, we can see on our axial T1 imaging a isointense mass centered in the posterior compartment, isointense of the surrounding calf muscles, and some peripheral calcification here. On our axial T2 FATSAT imaging, again, we can see this heterogeneous lesion with increased signal in the center and this dark line on the periphery or hypointensity correlating to the calcifications seen on prior radiograph. On our axial T1 FATSAT post contrast imaging, we can see heterogeneous enhancement of this lesion, which could be seen in myositis ossificans. However, its appearance could mimic an aggressive lesion. So history of trauma is paramount in evaluating this lesion and radiograph or CT could be performed to evaluate the development of calcification.
Video Summary
A 16-year-old at Stanford University presented with calf pain and was suspected of having myositis ossificans following a prior injury. Radiographs and CT scans revealed dense, curvilinear calcification in the gastrocnemius muscle. A follow-up bone scan showed increased uptake, typical for myositis ossificans. Over time, calcification formed peripherally and extended towards the center. MRI scans displayed heterogeneous enhancement and signal changes, consistent with myositis ossificans but potentially mimicking more aggressive lesions. The history of trauma was crucial for diagnosis, with radiographs and CT scans being essential in assessing calcification development.
Meta Tag
Edition
2nd Edition
Related Case
2nd Edition, CASE 37
Topic
Metabolic Disorders
Keywords
2nd Edition, CASE 37
2nd Edition
Metabolic Disorders
myositis ossificans
calcification
radiographs
trauma
diagnosis
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