A 55year old man with difficulty in walking&activity

 

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Doctor's Information

Name : Maryam
Family :Noori
Affiliation : ----------------
Academic Degree: ----------------
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : ----------------

 

Patient's Information

Gender : Male
Age : 55

 

Case Section

Muskuloskeletal System

 

Clinical Summary

 

A 55year old man with difficulty in walking&activit

 

Imaging Procedures and Findings

This middle aged athlete presents with a past history of sharp sudden calf pain, followed by swelling and ecchymosis from one month ago, now he has difficulty in walking & activity. Performed MRI showed, intramuscular edema in gastrocnemius muscle (both heads), extramuscular fluid, intramuscular subacute hematoma within medial head of gastrocnemius & plantaris muscles.

 

Discussion

Muscle Strain ranges from mild edema (grade 1) to complete fiber disruption (grade 3) with retraction. In acute phase (« 48 hours) hematoma is T1 isointense to muscle. In subacute phase (« 30 days) hematoma is high signal on T1 & T2w (methemoglobin). In chronic phase (> 30 days): hematoma is heterogeneous; if hemosiderin present. Strain or rupture of the gasrrocnemius-soleus muscle complex (sometimes known as tennis leg, a term that has also been used to refer to plantaris rupture) is a common sports injury seen in racquet sports, basketball, running, or skiing. There is a tear of the medial head of the gastrocnemius at the muscle- tendon junction, usually associated with soleus muscle rupture. The medial head of the gastrocnemius is larger than the lateral head and originates on the medial condyle and adjacent femur and capsule of the knee joint. It inserts on the calcaneus with the Achilles tendon. The gastrocnemius, composed of fast-twitch fibers, crosses both the knee and the ankle joints. The soleus muscle is composed of slow-twitch fibers. The size of the tear varies from a portion of the gastrocnemius to entire cross-sectional areas. There may be a feathery or diffuse edema pattern and irregularity of the intermuscular fascia. Localized muscle hemorrhage is usually found in grade 2 tears, and there is muscle discontinuity in grade 3 disruption. There may also be an associated plantaris musclerupture at the myotendinous junction.

 

Final Diagnosis

Subacute hematoma within plantaris & medial head of gastrocnemius muscles

 

References

Expert DDx musculoskletal. S.J.Manaster, et al. MRI in orthopedics & sports medicine. DW stoller, et al.

 

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