【双语病例】创伤性骨化性肌炎1例影像表现

1.What is the most likely diagnosis?

2. What are some causes for this abnormality?

3. When do you think the initial insult occurred?

4. Why does calcific myonecrosis occur?Does it look like this?

【双语病例】创伤性骨化性肌炎1例影像表现

【双语病例】创伤性骨化性肌炎1例影像表现

1.What is the most likely diagnosis?

最有可能的诊断?

2. What are some causes for this abnormality?

该病的病因?

3. When do you think the initial insult occurred?

外伤发生于什么时间?

4. Why does calcific myonecrosis occur?Does it look like this?

钙化性肌坏死的发病原因。

Myositis ossificans traumatica

1. Myositis ossificans traumatica secondaryto myonecrosis.

肌坏死继发创伤性骨化性肌炎。

2. Any condition that leads torhabdomyolysis, such as a crush injury, severe muscle strain, andelectrocution.任何可以引起横纹肌溶解的情况,如挤压伤、严重肌肉拉伤、电击等。

3. A long time ago.

4. Compartment syndrome. No, it is generally a sheet of calcification in one of the compartments in the calf.

骨室筋膜综合症。不像,钙化一般在小腿旁的骨室筋膜。

Reference

Yu JS: MR imaging of soft tissue trauma.Emergency Radiol3:181–194, 1996.

Cross-Reference

Musculoskeletal Imaging: THE REQUISITES,3rd ed, pp 523–526.

Comment

Myositis ossificans traumatica is a benign processcharacterized by the formation of an ossifying soft tissue mass or masses inskeletal muscle. The pathogenesis of myositisossificans is unknown. About 80% of cases involve the large muscles of theextremities, but locations about the scapula, posterior part of the neck,thorax, abdominal wall, and hip have been described.Pain, swelling, anddiminished range of motion are common clinical symptoms. The distribution inthis patient is extensive, caused by a crush injury to both upper thighs froman industrial accident many years ago.

创伤性骨化性肌炎是一种以骨骼肌内单发、多发骨性软组织肿块为特点的良性过程。骨化性肌炎的发病机理尚不清楚,80%发生于四肢大肌肉,也有报道发生于肩胛、颈后部、胸部、腹壁、骨盆等部位。最常见的临床症状为疼痛、肿胀、运动障碍等。此例病例中,患者病灶分布非常广泛,为多年前工业意外引起的双大腿挤压伤所致。

The radiographic findings parallel the histologicpattern of maturation. The initial radiographic finding is soft tissueswelling. After 3 weeks, floccular calcifications develop. At 6 to 8 weeks, lamellar bone with a well-defined cortex surrounds centralradiolucent areas. In mature lesions, dense peripheral ossification ischaracteristic, often associated with a radiolucent zone separating the massesfrom the underlying cortex. The magnetic imaging features also depend on thestage of

the lesion. Acute lesions are isointense tomuscle on T1W images. On T2W images, the signal intensity is higher than thatof fat, and the margins may appear heterogeneous owing to peripheral edema.Subacute lesions demonstrate a border of low signal intensity surrounding thelesion, corresponding to ossification. Centrally, the lesion may be isointenseor slightly higher in signal intensity compared to muscle on T1W images, reflectingareas of fatty infiltration.

该病的影像学表现与组织学成分的成熟程度相符合。最初,影像学表现为软组织肿胀;3周后逐渐产生絮状钙化;6-8周表现为板层骨,周边为边界清楚的骨性组织,中心为低信号无强化区;完全成熟的病灶周边可见钙化,钙化与正常骨皮质之间可见一线状透亮影。

The magnetic imaging features also depend on the stage of thelesion. Acute lesions are isointense to muscle on T1W images. On T2W images,the signal intensity is higher than that of fat, and the margins may appearheterogeneous owing to peripheral edema. Subacute lesions demonstrate a borderof low signal intensity surrounding the lesion, corresponding to ossification. Centrally,the lesion may be isointense or slightly higher in signal intensity compared tomuscle on T1W images, reflecting areas of fatty infiltration.

磁共振表现同样也与本病的分期有关。急性期病灶于T1WI呈等信号,T2WI信号强度略高于脂肪,边缘可因含铁血黄素沉着而成周边低信号环。亚急性期时,病灶周边骨化,呈低密度。常规MR T1WI上肿瘤呈等信号或略高于肌肉的信号,反映了脂肪浸润的情况。

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