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[
musculoskeletal imaging
]
FIGURE 1. (LEFT) Scintigraphy with technetium-99m methylene diphosphonate demonstrating intense radiotracer uptake within the quadriceps muscles bilaterally. The anterior view is on the left and the posterior view is on the right. FIGURE 2. (ABOVE) T2-weighted, fat-saturated magnetic resonance images of the thighs (axial view) demonstrating diffuse hyperintensity of the vastus lateralis (orange asterisks), vastus intermedius (white asterisks), and vastus medialis (blue asterisks) muscles.
Acute Exertional Rhabdomyolysis JAEHO CHO, MD, Department of Orthopedic Surgery, Seoul Paik Hospital, Seoul, Republic of Korea.
T
he patient was a 21-year-old man who was serving in the military. He was evaluated by an orthopaedic surgeon for a chief complaint of severe pain in both lower extremities that began 2 days prior after performing repetitive, vigorous squatting exercises. The patient denied taking supplements, illegal drugs, or other medications. Visual examination revealed edema of both thighs, predominantly anteriorly. Exquisite tenderness to palpation was noted through the quadriceps muscles bilaterally. There were no sensory or motor deficits, and distal pulses were intact. Due to concern over acute exertional
rhabdomyolysis, laboratory testing was completed, which revealed elevated serum creatine kinase and myoglobinuria. To localize and quantify the muscular involvement, scintigraphy with technetium-99m methylene diphosphonate was completed, which revealed intense radiotracer uptake within the quadriceps muscles bilaterally (FIGURE 1).1 To further assess the distribution and extent of the affected quadriceps muscles, magnetic resonance imaging was completed, which revealed diffuse hyperintensity of the vastus lateralis, vastus intermedius, and vastus medialis muscles bilaterally (FIGURE 2).3 The laboratory results and the
findings seen on diagnostic imaging were consistent with rhabdomyolysis.2 The patient was hospitalized for aggressive fluid replacement. After 24 hours, thigh edema and pain began to resolve and his serum creatine kinase levels decreased. The patient continued to be treated with complete rest and fluid replacement therapy for 2 weeks. At 3 months following symptom onset, after the completion of a rehabilitation program, the patient was able to return to full military service without any limitations. t J Orthop Sports Phys Ther 2013;43(12):932. doi:10.2519/ jospt.2013.0420
References 1. A izawa N, Suzuki Y, Akashi T, et al. [Clinical usefulness of scintigraphy with 99m technetium phosphates in rhabdomyolysis]. Kaku Igaku. 1990;27:801-807. 2. L amminen 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;62:326-330. 3. M oratalla MB, Braun P, Fornas GM. Importance of MRI in the diagnosis and treatment of rhabdomyolysis. Eur J Radiol. 2008;65:311-315. http://dx.doi.org/10.1016/j. ejrad.2007.03.033
932 | december 2013 | volume 43 | number 12 | journal of orthopaedic & sports physical therapy
43-12 Imaging-Cho.indd 1
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[
musculoskeletal imaging
]
FIGURE 1. (LEFT) Scintigraphy with technetium-99m methylene diphosphonate demonstrating intense radiotracer uptake within the quadriceps muscles bilaterally. The anterior view is on the left and the posterior view is on the right. FIGURE 2. (ABOVE) T2-weighted, fat-saturated magnetic resonance images of the thighs (axial view) demonstrating diffuse hyperintensity of the vastus lateralis (orange asterisks), vastus intermedius (white asterisks), and vastus medialis (blue asterisks) muscles.
Acute Exertional Rhabdomyolysis JAEHO CHO, MD, Department of Orthopedic Surgery, Seoul Paik Hospital, Seoul, Republic of Korea.
T
he patient was a 21-year-old man who was serving in the military. He was evaluated by an orthopaedic surgeon for a chief complaint of severe pain in both lower extremities that began 2 days prior after performing repetitive, vigorous squatting exercises. The patient denied taking supplements, illegal drugs, or other medications. Visual examination revealed edema of both thighs, predominantly anteriorly. Exquisite tenderness to palpation was noted through the quadriceps muscles bilaterally. There were no sensory or motor deficits, and distal pulses were intact. Due to concern over acute exertional
rhabdomyolysis, laboratory testing was completed, which revealed elevated serum creatine kinase and myoglobinuria. To localize and quantify the muscular involvement, scintigraphy with technetium-99m methylene diphosphonate was completed, which revealed intense radiotracer uptake within the quadriceps muscles bilaterally (FIGURE 1).1 To further assess the distribution and extent of the affected quadriceps muscles, magnetic resonance imaging was completed, which revealed diffuse hyperintensity of the vastus lateralis, vastus intermedius, and vastus medialis muscles bilaterally (FIGURE 2).3 The laboratory results and the
findings seen on diagnostic imaging were consistent with rhabdomyolysis.2 The patient was hospitalized for aggressive fluid replacement. After 24 hours, thigh edema and pain began to resolve and his serum creatine kinase levels decreased. The patient continued to be treated with complete rest and fluid replacement therapy for 2 weeks. At 3 months following symptom onset, after the completion of a rehabilitation program, the patient was able to return to full military service without any limitations. t J Orthop Sports Phys Ther 2013;43(12):932. doi:10.2519/ jospt.2013.0420
References 1. A izawa N, Suzuki Y, Akashi T, et al. [Clinical usefulness of scintigraphy with 99m technetium phosphates in rhabdomyolysis]. Kaku Igaku. 1990;27:801-807. 2. L amminen 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;62:326-330. 3. M oratalla MB, Braun P, Fornas GM. Importance of MRI in the diagnosis and treatment of rhabdomyolysis. Eur J Radiol. 2008;65:311-315. http://dx.doi.org/10.1016/j. ejrad.2007.03.033
932 | december 2013 | volume 43 | number 12 | journal of orthopaedic & sports physical therapy
43-12 Imaging-Cho.indd 1
11/18/2013 3:29:07 PM
