Semin Musculoskelet Radiol 2017; 21(04): 443-458
DOI: 10.1055/s-0037-1604001
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Muscle: Ischemia, Infarction, and Compartment Syndrome

Stephen M. Broski
1   Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota
,
Christin A. Tiegs Heiden
1   Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota
,
Michael D. Ringler
1   Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota
› Author Affiliations
Further Information

Publication History

Publication Date:
03 August 2017 (online)

Abstract

Muscle ischemia and infarction are associated with a variety of pathologic conditions and commonly encountered in busy imaging practices. This article reviews the most common clinical scenarios in which they are seen including compartment syndrome, diabetic myonecrosis, and rhabdomyolysis, focusing on the imaging findings and differential diagnosis for each disease process. Magnetic resonance imaging is increasingly useful in differentiating myonecrosis from muscle ischemia and myositis, and it is highly accurate in diagnosing the most common type of compartment syndrome.

 
  • References

  • 1 Blaisdell FW. The pathophysiology of skeletal muscle ischemia and the reperfusion syndrome: a review. Cardiovasc Surg 2002; 10 (06) 620-630
  • 2 Garner MR, Taylor SA, Gausden E, Lyden JP. Compartment syndrome: diagnosis, management, and unique concerns in the twenty-first century. HSS J 2014; 10 (02) 143-152
  • 3 Mauser N, Gissel H, Henderson C, Hao J, Hak D, Mauffrey C. Acute lower-leg compartment syndrome. Orthopedics 2013; 36 (08) 619-624
  • 4 von Keudell AG, Weaver MJ, Appleton PT. , et al. Diagnosis and treatment of acute extremity compartment syndrome. Lancet 2015; 386 (10000): 1299-1310
  • 5 Shadgan B, Menon M, O'Brien PJ, Reid WD. Diagnostic techniques in acute compartment syndrome of the leg. J Orthop Trauma 2008; 22 (08) 581-587
  • 6 Ringler MD, Litwiller DV, Felmlee JP. , et al. MRI accurately detects chronic exertional compartment syndrome: a validation study. Skeletal Radiol 2013; 42 (03) 385-392
  • 7 Shadgan B, Menon M, Sanders D. , et al. Current thinking about acute compartment syndrome of the lower extremity. Can J Surg 2010; 53 (05) 329-334
  • 8 McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome. Who is at risk?. J Bone Joint Surg Br 2000; 82 (02) 200-203
  • 9 Shelly MJ, Hodnett PA, MacMahon PJ, Moynagh MR, Kavanagh EC, Eustace SJ. MR imaging of muscle injury. Magn Reson Imaging Clin N Am 2009; 17 (04) 757-773 , vii
  • 10 Ritenour AE, Dorlac WC, Fang R. , et al. Complications after fasciotomy revision and delayed compartment release in combat patients. J Trauma 2008; 64 (2, Suppl): S153-S161 ; discussion S161–S162
  • 11 Hope MJ, McQueen MM. Acute compartment syndrome in the absence of fracture. J Orthop Trauma 2004; 18 (04) 220-224
  • 12 Sigamoney K, Khincha P, Badge R, Shah N. Compartment syndrome: challenges and solutions. Orthop Res Rev 2015; 7: 137-148
  • 13 McDonald S, Bearcroft P. Compartment syndromes. Semin Musculoskelet Radiol 2010; 14 (02) 236-244
  • 14 Konstantakos EK, Dalstrom DJ, Nelles ME, Laughlin RT, Prayson MJ. Diagnosis and management of extremity compartment syndromes: an orthopaedic perspective. Am Surg 2007; 73 (12) 1199-1209
  • 15 Rominger MB, Lukosch CJ, Bachmann GF. MR imaging of compartment syndrome of the lower leg: a case control study. Eur Radiol 2004; 14 (08) 1432-1439
  • 16 Garabekyan T, Murphey GC, Macias BR, Lynch JE, Hargens AR. New noninvasive ultrasound technique for monitoring perfusion pressure in a porcine model of acute compartment syndrome. J Orthop Trauma 2009; 23 (03) 186-193 ; discussion 193–194
  • 17 Wiemann JM, Ueno T, Leek BT, Yost WT, Schwartz AK, Hargens AR. Noninvasive measurements of intramuscular pressure using pulsed phase-locked loop ultrasound for detecting compartment syndromes: a preliminary report. J Orthop Trauma 2006; 20 (07) 458-463
  • 18 Litwiller DV, Amrami KK, Dahm DL. , et al. Chronic exertional compartment syndrome of the lower extremities: improved screening using a novel dual birdcage coil and in-scanner exercise protocol. Skeletal Radiol 2007; 36 (11) 1067-1075
  • 19 Clanton TO, Solcher BW. Chronic leg pain in the athlete. Clin Sports Med 1994; 13 (04) 743-759
  • 20 Styf J. Diagnosis of exercise-induced pain in the anterior aspect of the lower leg. Am J Sports Med 1988; 16 (02) 165-169
  • 21 Takebayashi S, Takazawa H, Sasaki R, Miki H, Soh R, Nishimura J. Chronic exertional compartment syndrome in lower legs: localization and follow-up with thallium-201 SPECT imaging. J Nucl Med 1997; 38 (06) 972-976
  • 22 Edwards Jr PH, Wright ML, Hartman JF. A practical approach for the differential diagnosis of chronic leg pain in the athlete. Am J Sports Med 2005; 33 (08) 1241-1249
  • 23 Gielen JL, Peersman B, Peersman G. , et al. Chronic exertional compartment syndrome of the forearm in motocross racers: findings on MRI. Skeletal Radiol 2009; 38 (12) 1153-1161
  • 24 Goubier JN, Saillant G. Chronic compartment syndrome of the forearm in competitive motor cyclists: a report of two cases. Br J Sports Med 2003; 37 (05) 452-453 ; discussion 453–454
  • 25 Pedowitz RA, Hargens AR, Mubarak SJ, Gershuni DH. Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg. Am J Sports Med 1990; 18 (01) 35-40
  • 26 van den Brand JG, Nelson T, Verleisdonk EJ, van der Werken C. The diagnostic value of intracompartmental pressure measurement, magnetic resonance imaging, and near-infrared spectroscopy in chronic exertional compartment syndrome: a prospective study in 50 patients. Am J Sports Med 2005; 33 (05) 699-704
  • 27 Fleckenstein JL, Canby RC, Parkey RW, Peshock RM. Acute effects of exercise on MR imaging of skeletal muscle in normal volunteers. AJR Am J Roentgenol 1988; 151 (02) 231-237
  • 28 Eskelin MK, Lötjönen JM, Mäntysaari MJ. Chronic exertional compartment syndrome: MR imaging at 0.1 T compared with tissue pressure measurement. Radiology 1998; 206 (02) 333-337
  • 29 Verleisdonk EJ, van Gils A, van der Werken C. The diagnostic value of MRI scans for the diagnosis of chronic exertional compartment syndrome of the lower leg. Skeletal Radiol 2001; 30 (06) 321-325
  • 30 George CA, Hutchinson MR. Chronic exertional compartment syndrome. Clin Sports Med 2012; 31 (02) 307-319
  • 31 Cheng YC, Lan HH, Shih CH. , et al. Magnetic resonance imaging of rhabdomyolysis: muscle necrosis versus ischemia. J Radiol Sci 2013; 38: 143-148
  • 32 O'Keefe RJ, O'Connell JX, Temple HT. , et al. Calcific myonecrosis. A late sequela to compartment syndrome of the leg. Clin Orthop Relat Res 1995; (318) 205-213
  • 33 Chason DP, Fleckenstein JL, Burns DK, Rojas G. Diabetic muscle infarction: radiologic evaluation. Skeletal Radiol 1996; 25 (02) 127-132
  • 34 Huang BK, Monu JU, Doumanian J. Diabetic myopathy: MRI patterns and current trends. AJR Am J Roentgenol 2010; 195 (01) 198-204
  • 35 Jelinek JS, Murphey MD, Aboulafia AJ, Dussault RG, Kaplan PA, Snearly WN. Muscle infarction in patients with diabetes mellitus: MR imaging findings. Radiology 1999; 211 (01) 241-247
  • 36 Kapur S, Brunet JA, McKendry RJ. Diabetic muscle infarction: case report and review. J Rheumatol 2004; 31 (01) 190-194
  • 37 Khoury NJ, el-Khoury GY, Kathol MH. MRI diagnosis of diabetic muscle infarction: report of two cases. Skeletal Radiol 1997; 26 (02) 122-127
  • 38 Ly JQ, Yi EK, Beall DP. Diabetic muscle infarction. AJR Am J Roentgenol 2003; 181 (05) 1216
  • 39 Trujillo-Santos AJ. Diabetic muscle infarction: an underdiagnosed complication of long-standing diabetes. Diabetes Care 2003; 26 (01) 211-215
  • 40 Horton WB, Taylor JS, Ragland TJ, Subauste AR. Diabetic muscle infarction: a systematic review. BMJ Open Diabetes Res Care 2015; 3 (01) e000082
  • 41 Grigoriadis E, Fam AG, Starok M, Ang LC. Skeletal muscle infarction in diabetes mellitus. J Rheumatol 2000; 27 (04) 1063-1068
  • 42 Kattapuram TM, Suri R, Rosol MS, Rosenberg AE, Kattapuram SV. Idiopathic and diabetic skeletal muscle necrosis: evaluation by magnetic resonance imaging. Skeletal Radiol 2005; 34 (04) 203-209
  • 43 Cunningham J, Sharma R, Kirzner A. , et al. Acute myonecrosis on MRI: etiologies in an oncological cohort and assessment of interobserver variability. Skeletal Radiol 2016; 45 (08) 1069-1078
  • 44 Delaney-Sathy LO, Fessell DP, Jacobson JA, Hayes CW. Sonography of diabetic muscle infarction with MR imaging, CT, and pathologic correlation. AJR Am J Roentgenol 2000; 174 (01) 165-169
  • 45 Karkhanis S, Botchu R, James S, Evans N. Bilateral calcific myonecrosis associated with epilepsy. Clin Radiol 2013; 68 (06) e349-e352
  • 46 Okada A, Hatori M, Hosaka M, Watanuki M, Itoi E. Calcific myonecrosis and the role of imaging in the diagnosis: a case report. Ups J Med Sci 2009; 114 (03) 178-183
  • 47 Chun YS, Shim HS. Calcific myonecrosis of the antetibial area. Clin Orthop Surg 2010; 2 (03) 191-194
  • 48 Janzen DL, Connell DG, Vaisler BJ. Calcific myonecrosis of the calf manifesting as an enlarging soft-tissue mass: imaging features. AJR Am J Roentgenol 1993; 160 (05) 1072-1074
  • 49 Jalil R, Roach J, Smith A, Mukundan C. Calcific myonecrosis: a case report and review of the literature. BMJ Case Rep 2012; 2012: bcr2012007186
  • 50 Dhillon M, Davies AM, Benham J, Evans N, Mangham DC, Grimer RJ. Calcific myonecrosis: a report of ten new cases with an emphasis on MR imaging. Eur Radiol 2004; 14 (11) 1974-1979
  • 51 Constantine S, Brennan C, Sebben R. Calcific myonecrosis: case report and radiopathological correlation. Australas Radiol 2007; 51 (Spec No): B77-B81
  • 52 Holobinko JN, Damron TA, Scerpella PR, Hojnowski L. Calcific myonecrosis: keys to early recognition. Skeletal Radiol 2003; 32 (01) 35-40
  • 53 O'Dwyer HM, Al-Nakshabandi NA, Al-Muzahmi K, Ryan A, O'Connell JX, Munk PL. Calcific myonecrosis: keys to recognition and management. AJR Am J Roentgenol 2006; 187 (01) W67-76
  • 54 Zohman GL, Pierce J, Chapman MW, Greenspan A, Gandour-Edwards R. Calcific myonecrosis mimicking an invasive soft-tissue neoplasm. A case report and review of the literature. J Bone Joint Surg Am 1998; 80 (08) 1193-1197
  • 55 Larson RC, Sierra RJ, Sundaram M, Inwards C, Scully SP. Calcific myonecrosis: a unique presentation in the upper extremity. Skeletal Radiol 2004; 33 (05) 306-309
  • 56 Ryu KN, Bae DK, Park YK, Lee JH. Calcific tenosynovitis associated with calcific myonecrosis of the leg: imaging features. Skeletal Radiol 1996; 25 (03) 273-275
  • 57 Bagley WH, Yang H, Shah KH. Rhabdomyolysis. Intern Emerg Med 2007; 2 (03) 210-218
  • 58 Melli G, Chaudhry V, Cornblath DR. Rhabdomyolysis: an evaluation of 475 hospitalized patients. Medicine (Baltimore) 2005; 84 (06) 377-385
  • 59 Chavez LO, Leon M, Einav S, Varon J. Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice. Crit Care 2016; 20 (01) 135
  • 60 Lu CH, Tsang YM, Yu CW, Wu MZ, Hsu CY, Shih TT. Rhabdomyolysis: magnetic resonance imaging and computed tomography findings. J Comput Assist Tomogr 2007; 31 (03) 368-374
  • 61 Moratalla MB, Braun P, Fornas GM. Importance of MRI in the diagnosis and treatment of rhabdomyolysis. Eur J Radiol 2008; 65 (02) 311-315
  • 62 Shintani S, Shiigai T. Repeat MRI in acute rhabdomyolysis: correlation with clinicopathological findings. J Comput Assist Tomogr 1993; 17 (05) 786-791
  • 63 Révelon G, Rahmouni A, Jazaerli N. , et al. Acute swelling of the limbs: magnetic resonance pictorial review of fascial and muscle signal changes. Eur J Radiol 1999; 30 (01) 11-21
  • 64 Stock KW, Helwig A. MRI of acute exertional rhabdomyolysis—in the paraspinal compartment. J Comput Assist Tomogr 1996; 20 (05) 834-836
  • 65 Barloon TJ, Zachar CK, Harkens KL, Honda H. Rhabdomyolysis: computed tomography findings. J Comput Tomogr 1988; 12 (03) 193-195
  • 66 Lamminen AE, Hekali PE, Tiula E, Suramo I, Korhola OA. Acute rhabdomyolysis: evaluation with magnetic resonance imaging compared with computed tomography and ultrasonography. Br J Radiol 1989; 62 (736) 326-330
  • 67 Nakahara K, Tanaka H, Masutani K. , et al. The value of computed tomography and magnetic resonance imaging to diagnose rhabdomyolysis in acute renal failure. Nephrol Dial Transplant 1999; 14 (06) 1564-1567
  • 68 Towers MJ, Downey DB, Poon PY. Psoas muscle calcification and acute renal failure associated with nontraumatic rhabdomyolysis: CT features. J Comput Assist Tomogr 1990; 14 (06) 1027-1029