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Sonography of Diabetic Muscle Infarction with MR Imaging, CT, and Pathologic Correlation

Lydia O. Delaney-Sathy1, David P. Fessell1, Jon A. Jacobson1 and Curtis W. Hayes1

1 Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., TC 2910, Ann Arbor, MI 48109-0326.



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  		Fig. 1. —26-year-old woman with diabetes mellitus and acute onset of pain in left thigh.

A, Transverse sonogram reveals hypoechoic area, which is limited to vastus intermedius and vastus lateralis muscles (arrowheads), with multiple internal echogenic lines (open arrows), compatible with muscle fibers. Also, note outer cortex of femur (curved arrow) and rectus femoris muscle (solid straight arrows). Note that posterior acoustic enhancement cannot be adequately assessed because femur is directly beneath lesion.

 


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  		Fig. 2. —42-year-old woman with diabetes and acute pain in left thigh.

A, Axial sonogram reveals well-defined, hypoechoic lesion involving adductor magnus muscle (black arrows and cursors). Note presence of posterior acoustic enhancement. Also, note echogenic structures (white arrows), which appeared linear at real time, coursing through lesion.

 


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  		Fig. 3. —26-year-old diabetic man with acute onset of pain in left thigh.

A, Axial sonogram shows well-defined hypoechoic area (straight black arrows) with apparent increased through-transmission involving vastus medialis muscle. Echogenic linear structures (white arrows) course through lesion. Note outer cortex (curved arrows) of femur.

 


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  		Fig. 1. —26-year-old woman with diabetes mellitus and acute onset of pain in left thigh.

B, Corresponding axial T1-weighted MR image of left thigh shows no significant signal intensity abnormality of vasti muscles and adductor magnus muscle (arrows).

 


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  		Fig. 1. —26-year-old woman with diabetes mellitus and acute onset of pain in left thigh.

C, Axial T2-weighted MR image with fat saturation shows diffusely increased signal intensity involving discrete muscle groups: vastus medialis, vastus lateralis, vastus intermedius, and adductor magnus muscles (arrows). Note increased linear signal intensity in subcutaneous fat and fascia (arrowheads), indicating subcutaneous edema and subfascial fluid.

 


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  		Fig. 1. —26-year-old woman with diabetes mellitus and acute onset of pain in left thigh.

D, Axial contrast-enhanced T1-weighted MR image with fat saturation reveals diffuse enhancement of vastus muscles (black arrows): ring enhancement of vastus intermedius and vastus lateralis muscles (white arrows) and mild enhancement of adductor magnus muscle.

 


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  		Fig. 2. —42-year-old woman with diabetes and acute pain in left thigh.

B, Corresponding axial T1-weighted MR image shows mild heterogeneous signal intensity in adductor magnus muscle (arrows) and linear low signal intensity in subcutaneous fat (arrowheads), indicating subcutaneous edema.

 


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  		Fig. 2. —42-year-old woman with diabetes and acute pain in left thigh.

C, Axial T2-weighted MR image with fat saturation shows diffusely increased signal intensity involving adductor magnus muscle (arrows). Note linear increased signal intensity in subcutaneous fat and fascial planes (arrowheads), indicating subcutaneous edema and subfascial fluid.

 


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  		Fig. 2. —42-year-old woman with diabetes and acute pain in left thigh.

D, Axial contrast-enhanced T1-weighted MR image with fat saturation shows marked ring enhancement (black arrows) with some internal enhancement (white arrows) involving adductor magnus muscle.

 


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  		Fig. 3. —26-year-old diabetic man with acute onset of pain in left thigh.

B, Corresponding axial contrast-enhanced CT image of left thigh shows well-defined ring enhancement (arrows) surrounding low-attenuation areas in vastus intermedius and vastus medialis muscles. Note linear fluid attenuation in subcutaneous tissues, compatible with subcutaneous edema.

 


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  		Fig. 2. —42-year-old woman with diabetes and acute pain in left thigh.

E, Axial unenhanced CT image of both thighs shows diffuse enlargement of symptomatic left thigh. Note low attenuation throughout adductor magnus muscle (arrows), which is enlarged to a greater degree than other thigh muscles. Also, note extensive subcutaneous edema.

 


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  		Fig. 1. —26-year-old woman with diabetes mellitus and acute onset of pain in left thigh.

E, Photomicrograph shows myonecrosis (short straight arrows), variable fiber size, abundant fibrous stroma (curved arrows), multinucleated muscle fibers (long straight arrows), and lack of inflammatory cells. (H and E, x100)

 

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