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Phoenix Diagnostic Clinic

 Non-infection (idiophatic)
  • dermatomyositis
  • polymyositis
  • focal myositis

 Without necrosis

  • bacterial myositis (pyomiositis)

 Necrotizing fasciitis



 • Rare condition
 • Prevalent in tropical countries (“tropical myositis”, “bacterial myositis”)
 • Immunocompromised patients, i.m. drug abusers
 • Rising cases in western countries – related to HIV
 • 66% - 94% different histopathological changes in muscle
 • most common MSK complication on AIDS patients
 • S pyogenes, Mycobacterium tuberculosis, M aviumintracellulare

Pyomyositis - Role of MRI
 – Dif idiophatic myositis – pyomyositis
    Idiophatic myiositis is ussualy bilateral
 – Dif lymphedema – pyomyositis
    Muscle edema with no enhancement
 – Dif cellulitis – pyomyositis
    Disproportional involvement of subcutaneous tissue
 – Presence of phlegmon, abscesses
    Must be differentiated from cystic tumors, seroma, hematoma

    Role of MRI: patient‘s management
 – Clinical presentation is nonspecific
 – May be fatal if is not recognized
 – One of the few curable conditions in AIDS

    MRI is the method of choice

Pyomyositis - MR Findings

• Phlegmon with diffuse enhancement
• Abscesses
• Thickening of muscle fascia
• Presence of hemorhage
• Presence of necrosis (myonecrosis)

Pyomyositis versus Polymyositis
Idiopatic polymyositisIdiopatic polymyositis
Idiopatic polymyositis

Necrotizing Fasciitis

 • Rapidly progressing infection (common in HIV)
 • Extensive necrosis of superficial and deep anatomical planes
 • Accompanied by severe systemic toxicity
 • Mortality rate 73%
          M Rouge, Surgery 1982
 • Indication of MRI in emergency

Necrotizing faciitis MRI findings

 • More severe deeper involvement:
 – thickening of affected fascias
 – fluid collection along deep fascia sheet
 – extension into deep muscular septa and muscles
 – muscle necrosis

Role of MRI:

 – evaluation of the extent and depth of the process and involvement of adjacent structures
 – follow up for assessment of late development of necrosis

M, 30 y. HIV infection, abscess of right tight
and necrotizing fasciitis of left distal tight.
Necrotizing Fasciitis
Necrotizing faciitis
November 4, 2009

Phoenix Diagnostic Clinic, Bucharest

This site is primarily intended for use by qualified medical or sport professionals.
If you are a consumer, you should evaluate the information together with your physician or other qualified healthcare professional.
The information provided here is for educational and informational purposes only and should not be considered as a medical advice.
As medical and sport science is permanently changing, we (authors and publishers) use our best efforts to provide accurate information, but we can not warrant that the information in this article and web site is accurate, complete or up-to-date.
This article reflects the opinions and judgments of it's author and may be further updated.
If you have questions regarding this article, please contact the author.
Information belongs to Phoenix Diagnostic Clinic, Bucharest

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