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Diabetic Skeletal Muscle Necrosis

- Discussion: (tumoriform focal muscular degeneration);
     - poorly defined process which occurs in long term diabetics;
     - other names for this syndrome include: tumoriform focal muscular degeneration and idiopathic diabetic muscle infarction;
     - may be confused w/ sarcoma, deep infection, or even a compartment syndrome (the mass may be very tender);
     - most often affects the quadriceps, and less often the thigh adductors and gastroc-soleus muscles are involved;
     - labs: elevated creatinine kinase will be increased in 50% of these patients;
     - MRI findings:
           - absence of discrete mass and MRI signal pattern consistent w/ intra-muscular edema and inflammation involving one or more 
                  major muscle groups;
                  - look for significant increased signal on T2 (and to a lesser extent T1);
           - in diabetic muscle necrosis, look for involvement of non-continguous muscle compartments which help distinguish DMI from polymyositis;
     - closed needle biopsy may be needed in some cases in order to clinch the diagnosis;
           - note that the histologic appearance of DMI may appear similar to polymyositis;
     - pitfalls:
           - attempts to excise the necrotic muscle or to begin aggressive PT are associated w/ a
                   high rate of complications, recurrent disease, and/or recurrence of symptoms;
     - treated conservatively, symptoms usually subside within 6 months;
     - references:
           - Idiopathic necrosis of skeletal muscle in patients who have diabetes. Report of four cases and review of the literature.
           - Diabetic muscle infarction: radiologic evaluation.
           - MRI evaluation of diabetic muscle infarction.
           - Clinical and radiographic aspects of idiopathic diabetic muscle infarction.


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