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 Transducer 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. 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. 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. 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. 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. #7 - Video View Video Short axis cine of the quadriceps muscle and myositis ossificans from proximal to distal. Interpretation Image Interpretation: Initial presence of a large anechoic fluid collection with internal septations within the vastus intermedius approximately 2 weeks after injury consistent with an intramuscular hematoma. 4 weeks post-injury: Presence of hyperechoic foci with posterior acoustic shadowing measuring 12.3cm in long axis within the vastus intermedius representing calcifications consistent with myositis ossificans. Teaching Pearl: Myositis ossificans most often appears weeks after muscle trauma, commonly in the quadriceps, and may follow a contusion, hematoma, or repeated injury. Ultrasound can follow the transition from an intramuscular hematoma to echogenic mineralization with posterior acoustic shadowing. Early lesions can be nonspecific hematomas, while maturation over time supports the diagnosis of myositis ossificans. Persistent growth, unusual pain, lack of trauma history, or atypical imaging features should prompt further imaging to exclude tumor or infection. References: 1. Abate M, Salini V, Rimondi E, Errani C, Alberghini M, Mercuri M, Pelotti P. Post traumatic myositis ossificans: sonographic findings. J Clin Ultrasound. 2011;39(3):135-140. doi:10.1002/jcu.20792 2. Lacout A, Jarraya M, Marcy PY, Thariat J, Carlier RY. Myositis ossificans imaging: keys to successful diagnosis. Indian J Radiol Imaging. 2012;22(1):35-39. doi:10.4103/0971-3026.95402 3. Saad A, Azzopardi C, Patel A, Davies AM, Botchu R. Myositis ossificans revisited - the largest reported case series. J Clin Orthop Trauma. 2021;17:123-127. doi:10.1016/j.jcot.2021.03.005
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Authors, Editors, Case Information

Unlabeled Long Axis View of the Quadriceps with Hematoma

Labeled Long Axis View of Quadriceps with Hematoma

Unlabeled Long Axis View of the Quadriceps with Myositis Ossificans

Labeled Long Axis View of Quadriceps with Myositis Ossificans

Unlabeled Short Axis View of Quadriceps with Myositis Ossificans

Labeled Short Axis View of Quadriceps with Myositis Ossificans

#7 - Video

Interpretation

UPCOMING EVENTS

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