Myositis Ossificans

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Myositis Ossificans

Authors, Editors, Case Information Author: Charis Hoppe, BSc Affiliation: University of California, San Francisco (UCSF) Co Author(s): William Berrigan, MD Senior Editor: Laura Mattson, DO Clinical Vignette: 16-year-old male high school football athlete presenting after right thigh injury sustained during football practice 2 weeks prior presents with continued anterior thigh pain with ambulation, knee flexion, and with a decreased range of motion. Type of Probe Used: GE S8 ML6-15 LAX quadriceps Long axis view of the right quadriceps muscle. SAX quadriceps Short axis view of the right quadriceps muscle. LAX quad labeled Long axis view of the right quadriceps muscle labeled. SAX quadriceps labeled Short axis view of the right quadriceps muscle labeled. Interpretation Image Interpretation: Focused ultrasound of the right thigh demonstrates echogenic mineralization within the vastus intermedius muscle measuring 10.22 cm in diameter with small surrounding hypoechoic fluid collection. These findings are consistent with myositis ossificans within the vastus intermedius. Teaching Pearl: Myositis ossificans is a self-limited condition of benign, heterotopic bone growth often following trauma in athletes. The most common sites of occurrence include the brachialis, quadriceps, and adductor muscle groups and there is often an inciting injury such as a contusion, hematoma, or microinjury from overuse. Patients may present with localized pain, a palpable mass, and adjacent joint stiffness with associated reduced range of motion. A lesion in the thigh can also result in reduced weight-bearing ability and decreased knee flexion. Primary treatment for myositis ossificans includes gradual rehabilitation of flexibility and strength over a two month to one year period, with minimization of pain. Persistent symptoms may warrant surgical excision. Diagnostic ultrasound can lead to early identification of a lesion, prevent inaccurate diagnosis of a muscle strain, and is useful for monitoring progression. Ultrasound findings appear 2 weeks prior to radiographs, which usually develop 3-4 weeks post injury. Early phases demonstrate decreased echogenicity of the muscle with sheets of peripheral echogenic material. With increasing ossification, coarse calcifications accompanied by acoustic shadowing appear often parallel to the diaphysis. Findings must be differentiated from a malignant lesion such as osteosarcoma by identifying the "zonal phenomenon" of myositis ossificans on ultrasound, most evident at least two weeks after injury. The zonal phenomenon is marked by the lesion progressively calcifying from the periphery to the center, as opposed to osteosarcomas which calcify from the center to the periphery. Additionally, myositis ossificans will not have connection to the adjacent bone.
NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.

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Authors, Editors, Case Information

LAX quadriceps

SAX quadriceps

LAX quad labeled

SAX quadriceps labeled

Interpretation

UPCOMING EVENTS

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