Abstract
A 31-year-old man presented with 2-week history of back pain. He had no history of trauma. A lumbar magnetic resonance imaging showed a lesion in the left paraspinal muscle at the L4 level. The lesion was globally isointense on T1-weighted images and slightly hyperintense on T2-weighted imaging. The mass strongly enhanced on contrast-enhanced T1-weighted images (Fig. 1). The lesion showed intense fluorodeoxyglucose uptake on positron emission tomography-computed tomography, suggesting a malignant process (Fig. 2). Biopsy of the lesion was performed and histopathologic examination was consistent with myositis ossificans. Myositis ossificans is an inflammatory pseudotumor that originates from the muscle and corresponds to heterotopic new bone formation in soft tissue [ [1] Olsen K.M. Chew F.S. Tumoral calcinosis: pearls, polemics, and alternative possibilities. Radiographics. 2006; 26: 871-885 Crossref PubMed Scopus (185) Google Scholar ]. Histologically, bone maturation occurs from the periphery to the center, and this is the most important diagnostic feature of myositis ossificans [ [2] Jung D.Y. Cho K.T. Roh J.H. Non-traumatic myositis ossificans in the lumbosacral paravertebral muscle. J Korean Neurosurg Soc. 2013; 53: 305-308 Crossref PubMed Scopus (12) Google Scholar ]. Computed tomography scan is more sensitive than radiography in depicting the small peripheral calcifications early. Positron emission tomography is nonspecific it shows tracer uptake, only showing decreased uptake as pain decreases and the lesion matures [ [3] Koob M. Durckel J. Dosch J.C. Entz-Werle N. Dietemann J.L. Intercostal myositis ossificans misdiagnosed as osteosarcoma in a 10-year-old child. Pediatr Radiol. 2010; 40: S34-7 Crossref PubMed Scopus (15) Google Scholar ]. Fig. 2Axial (Left) fluorodeoxyglucose-positron emission tomography-computed tomography (FDG-PET-CT) scan shows intense FDG uptake in the lesion (white arrows), and the axial (Right) CT component of PET-CT scan shows a lesion in the left paraspinal muscle, with peripheral ossifications in the left paraspinal muscle at the L4 level (white arrowheads). View Large Image Figure Viewer Download Hi-res image
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