Mahoney Flashcards
1
Q
Fluid shows up how on T1 MRI vs T2
A
- T1 = FLUID SHOWS UP DARK
- T2 = FLUID SHOWS UP WHITE
2
Q
Describe how diabetic myonecrosis will show up with IV gadolinium
A
- IV gadolinium on a T1 will show a DARK CENTRAL AREA surrounded by BRIGHT RIM
- could be pyomyositis
3
Q
describe clinical features of Diabetic myonecrosis
A
- Pain and swelling in ANTERIOR THIGH (80%) or calf pain (20%
- No specific laboratory marker, except LEUKOCYTOSIS seen in < 10% of cases and elevated CK in 50% of cases
4
Q
describe pathogesis of diabetic myonecrosis
A
- vascular disease –> ischemia –> soft tissue swelling –> incraesed pressure –> decreased blood flow
- Hypercoagulability
- increase factor VII activity
5
Q
How to diagnose Diabetic myonecrosis
A
MRI
- increased intramuscular and perimuscular signal on T2 and gadolinium-enhacned T1 images
- isointense or hypointense (dark) on T1 images due to increased water content
- may have small focal area of rim enhancement that represents infarction or necrosis-rim enahncement occurs without gadolinium and is seen on T2
6
Q
describe Treatment
A
- supportive (rest, analgesia)
- SELF-LIMITING DISEASE
7
Q
General things about diabetic myonecrosis
A
- occurs in poorly-controlled diabetics
- consider Dx in any diabetic with thigh pain and swelling
- MRI is daignostic modaility of choice
- biopsy is GOLD STANDARD for diagnosis, but should be avoided due to possible complicatiosn
- Tx is supportive; symptoms resolve in weeks to months
8
Q
describe prolonged risk after symptoms resolve
A
- risk of recurrence in IPSA - or contralateral leg is HIGH
- long term prognosis is poor, since myonecrosis is a marker for significant systemic vascular complication - check patient for retinopathy, nephropathy, carotid and cardiac disease
9
Q
what does an non-infectious muscle appear like on MRI
A
- NOn-infectious muscle of thigh with IV gadolinium on T1:
–> ABSENCE OF A UNIFORM CENTRAL AREA OF DECREASED SIGNAL INTENSITY (DARK) AND NO UNIFORM “RIM” SIGN
