Quadriceps Hematoma And Myositis Ossificans

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Quadriceps Hematoma And Myositis Ossificans

Authors, Editors, Case Information Author: Brady Fleshman, MD Affiliation: University of Missouri Senior Editor: William Denq, MD Clinical Vignette: 22-year-old male Division I basketball player presents to clinic for re-aspiration of large quadricep hematoma that was sustained during a basketball game about four weeks prior. Initial aspiration was completed two weeks prior. Athletic trainer stated right thigh swelling had recurred, and the patient was having limited knee flexion. Type of Probe Used: C1-5-RS Wideband Convex Array Probe Labeled Short Axis View of Quadriceps with Myositis Ossificans Labeled short axis view of the right quadriceps muscles with myositis ossificans four weeks after initial injury and two weeks after aspiration. #2 - Video View Video Cine short axis evaluation of the quadriceps muscle and myositis ossificans from proximal to distal. Labeled Long Axis View of Quadriceps with Myositis Ossificans Labeled long axis view of the right quadriceps muscles with myositis ossificans four weeks after initial injury and two weeks after aspiration. Labeled Long Axis View of Quadriceps with Hematoma Labeled long axis view of the right quadriceps muscle with hematoma two weeks after the initial injury. Unlabeled Long Axis View of the Quadriceps with Myositis Ossificans Unlabeled long axis view of the right quadriceps muscles with myositis ossificans four weeks after initial injury and two weeks after aspiration. Unlabeled Short Axis View of Quadriceps with Myositis Ossificans Unlabeled short axis view of the right quadriceps muscles with myositis ossificans four weeks after initial injury and two weeks after aspiration. Unlabeled Long Axis View of the Quadriceps with Hematoma Unlabeled long axis view of the right quadriceps muscle with hematoma two weeks after the initial injury. Interpretation Image Interpretation: Images 1 and 4 show a large intramuscular hematoma with internal septations within the vastus intermedius approximately 2 weeks after injury, when 100ml of blood was aspirated. Image 2, 3, 5, and 6 show hyperechoic calcifications with posterior acoustic shadowing measuring 12.3cm in long axis within the vastus intermedius. Teaching Pearl: Myositis Ossificans (MO) usually presents 4-12 weeks after a trauma and is most common in young males. The incidence of MO following trauma is between 9-17%. Approximately three-fourths of cases affect the lower limb with the most common muscle being the vastus intermedius. Repetitive trauma, which is common in basketball, is one of the most common triggering factors. Peripheral hyperechoic rim with posterior acoustic shadowing helps distinguish MO from other more serious conditions. The mainstay of management is conservative with nonsteroidal anti-inflammatory drugs and physical therapy focusing on improved range of motion. Surgical excision is a definitive treatment for MO if the patient continues to be symptomatic. This should not be completed until the lesion has fully ossified, which is typically 6-12 months after injury. Reference: Saad, A., Azzopardi, C., Patel, A., Davies, A. M., & Botchu, R. (2021). Myositis ossificans revisited – the largest reported case series. Journal of Clinical Orthopaedics and Trauma, 17, 123–127. https://doi.org/10.1016/j.jcot.2021.03.005
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

Labeled Short Axis View of Quadriceps with Myositis Ossificans

#2 - Video

Labeled Long Axis View of Quadriceps with Myositis Ossificans

Labeled Long Axis View of Quadriceps with Hematoma

Unlabeled Long Axis View of the Quadriceps with Myositis Ossificans

Unlabeled Short Axis View of Quadriceps with Myositis Ossificans

Unlabeled Long Axis View of the Quadriceps with Hematoma

Interpretation

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