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.
Highlights
Calcific myonecrosis is a rare soft tissue condition that mainly occurs after a long period of time post trauma
The disease is thought to initially arise from compartment syndrome within a confined space resulting in necrosis and fibrosis based on histology [2], followed by repeated intralesional hemorrhage causing mass enlargement and calcification [3], late focal enlargement of the mass, which is thought to be caused by herniation through the muscle fascia [4]
Evidence of muscle necrosis caused by compartment syndrome before calcific myonecrosis has been previously reported based on past history [1]
Summary
Calcific myonecrosis is a rare soft tissue condition that mainly occurs after a long period of time post trauma. A 69‐year‐old woman with a history of left distal fibula fracture 46 years ago, which was treated with open reduction and internal fixation, noticed swelling of her lower limb She had been asymptomatic and had not undergone any treatments for the past 20 years, but was referred to our outpatient clinic for investigation of a suspected malignant tumor detected on plain radiograph (Fig. 1A). After a period of 55 years without attending any medical institution, the man was referred to our outpatient clinic because of pain in the right anterior lower leg and growth of a mass lesion over 2 months. Computed tomography more clearly characterized the structure of the fusiform masses, demonstrating a central homogeneous component with scattered internal calcification covered by calcified capsules broadly following the fascia (Fig. 3B). Antibiotic treatment was required for 5 months and the patient attended the outpatient clinic for wound care, the wound had still not completely healed 1 year after incision
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