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Joseph Junewick, MD FACR
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Dermatomyositis

Case Detail

Anatomy: Musculoskeletal
Borders
Heather Borders, MD
Diagnostic Category: Infectious-Inflammatory
Created: over 3 years ago
Updated: over 3 years ago
Tags: PEDS
Modality/Study Types: MRI
Activities:
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History

8 year old female with muscle pain and weakness


Case Images


Diagnosis

Dermatomyositis

Findings

Symmetric T2 hyperintensity and enhancement involving all visualized musculature. There was relative sparing of hamstrings and gluteals. Mild reticular subcutaneous edema. No abscess or other finding to suggest infection.

Discussion

Dermatomyositis is an idiopathic inflammatory myopathy of striated muscle and skin. There is a characteristic skin rash and characteristic changes on muscle biopsy. Peak pediatric age is 5-14 years.

Five diagnostic criteria: symmetric proximal muscle weakness, characteristic muscle biopsy changes, laboratory changes, skin rash, emg abnormality.

Imaging findings are not included in these five major diagnostic criteria but the distribution on imaging is suggestive and can help direct biopsy.

The differential includes: infectious myositis, post traumatic myositis, subacute denervation, radiation therapy.

Imaging demonstrates increased fluid signal within the pelvic and thigh (proximal>distal) musculature with relative sparing of the hamstrings and gluteals. There is commonly enhancement with contrast. Reticular signal abnormality may be demonstrated in the subcutaneous fat. Changes are typically bilateral and symmetric. Chronically, there may be soft tissue calcification, which may become sheet like. Also, chronic muscle atrophy/fatty replacement.

Patients may develop interstitial lung disease. There is an association with malignancy. Treatment is with corticosteroids and patients may develop AVN.

Reference

StatDx: Dermatomyositis. Christopher Anton.
MRI imaging in children with Dermatomyositis. Hernandez et al. 161 (2): 359. (1993)



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