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Joseph Junewick, MD FACR
over 7 years ago
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Myositis Ossificans

Case Detail

Anatomy: Musculoskeletal
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Trauma
Created: over 6 years ago
Updated: over 6 years ago
Tags: PEDS
Modality/Study Types: US CR
Activities:
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History

Teenager with anterior mid-thigh pain.


Case Images


Diagnosis

Myositis Ossificans

Findings

US – Disordered echogenicity of vatus intermedius muscle. Note the normal echogenicity of the overlying rectus femoris muscle. (US was ordered to rule-out deep venous thrombosis; no DVT was seen).

CR – Radiographic examination obtained 6 weeks after the onset of symptoms demonstrates linear calcification in the deep thigh musculature.

Discussion

Myositis ossificans is a benign, self-limiting, solitary lesion. The pathogenesis is unknown; often there is no history of antecedent trauma and inflammation is absent on histological evaluation.

Symptoms include: pain, tenderness and mass/swelling. Mytositis ossificans most often occurs in young adults while it is rare in children (preteens). Most lesions involve the larger muscles of the extremities. Surgical excision is curative.

Initial imaging is often normal. Faint calcifications may be present by 2 weeks and circumscribed calcified mass is evident by 6-8 weeks. Most lesions are deep and adjacent but separate from the periosteum. Mineralization occurs from the periphery inward. US may show disorganization of the muscle fascicles and swelling. As the lesion matures, peripheral calcification becomes visible.

Reference

Lee JC, Healy J. Sonography of Lower Limb Muscle Injury. AJR 2004; 182:341-351.

Kransdorf MJ, Meis JM. Extraskeletal osseous and cartilaginous tumors of the extremities. RadioGraphics (1993); 13:853-884.



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