Diabetic myonecrosis-MRI

A 44-year-old woman with well  controlled  diabetes presented with intense pain in the left femur and local edema. Creatine kinase levels were slightly  elevated. A diabetic myositis diagnosis was established. Diabetic muscle infarction occurs most commonly in insulin-dependent patients (85%) with poorly controlled diabetes and concomitant end-organ complications. Average time of insulin use prior to diagnosis is 14 years. There is equal gender involvement. The pathogenesis of diabetic myonecrosis is unclear. Theories include occlusive peripheral vascular disease in the affected muscles, implicating arteriosclerosis obliterans as a cause of the inadequate perfusion and resultant ischemia. Other theories include endothelial damage from microangiopathy with an activated coagulation cascade, eventually causing a hypercoagulable state leading to ischemia and subsequent muscle necrosis. Case submitted by- Dr Nikos Vougioukli