Myositis Ossficans

Myositis ossificans circumscripta is another well-known sequela of muscle injury often affecting larger muscles in the extremities [10,18,23,24,135]. Myositis ossificans presents diagnostic imaging difficulties because of variable imaging appearance, which can be aggressive and overlap with neoplastic processes.

The cause is usually blunt trauma, although burns and paralysis have also been implicated, but often no traumatic history is present. Acute to subacute lesions are ill defined and isointense to muscle on T1-weighted images and heterogeneous on T2-weighted images. There is often a large area of surrounding edema, and at this stage, the lesion may be difficult to distinguish from a neoplasm. More mature lesions are better defined with fat signal intensity from

Fascial Nerve Herniation
Fig. 31. Axial T1-wieghted images reveal subtle contour defect of medial gastrocnemius on the left (arrows) consistent with a small fascial herniation, which was much more evident on physical exam.

ossification on both T1- and T2-weighted images and with little or no edema. Clinical history and sequential imaging (radiographs and CT) are critical to prevent misdiagnosis.

Calcific myonecrosis is a rare complication of muscle trauma that is associated with peripheral nerve injury and usually affects a single muscle [18] (Fig. 32). It is best evaluated with CT or MR demonstrating plaque-like peripheral calcification of the muscle with central fluid [136].

Myositis Ossificans Iliopsoas
Fig. 32. Radiograph of the pelvis with cylindrical peripheral calcifications associated with calcific myonecrosis or old hematoma of the distal iliopsoas muscle on the right.

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