Emergency Radiology

, Volume 16, Issue 4, pp 267–276 | Cite as

MR imaging of urgent inflammatory and infectious conditions affecting the soft tissues of the musculoskeletal system

Review Article

Abstract

Soft tissue infections and inflammatory conditions of the musculoskeletal system are a group of disorders commonly seen by emergency room physicians and radiologists. Many of these entities can either be limb- or life-threatening. Magnetic resonance imaging is currently the best imaging modality to evaluate these conditions. In this review, the characteristic imaging findings of cellulitis, abscess formation, necrotizing fasciitis, pyomyositis, diabetic ischemic infarction, acute and exertional compartment syndromes, and rhabdomyolysis will be emphasized as well as imaging factors that can help to differentiate these disorders.

Keywords

MR imaging Infection Musculoskeletal system Inflammation Muscles 

References

  1. 1.
    Fayad LM, Carrino JA, Fishman EK (2007) Musculoskeletal infection: role of CT in the emergency department. Radiographics 27:1723–1736. doi: 10.1148/rg.276075033 PubMedCrossRefGoogle Scholar
  2. 2.
    McHenry CR, Piotrowski JJ, Petrinic D et al (1995) Determinants of mortality for necrotizing soft-tissue infections. Ann Surg 221:558–565. doi: 10.1097/00000658-199505000-00013 PubMedCrossRefGoogle Scholar
  3. 3.
    Revelon G, Rahmouni A, Jazaerli N et al (1999) Acute swelling of the limbs: magnetic resonance pictorial review of fascial and muscle signal changes. Eur J Radiol 30:11–21. doi: 10.1016/S0720-048X(98)00119-3 PubMedCrossRefGoogle Scholar
  4. 4.
    Rahmouni A, Chosidow O, Mathieu D et al (1994) MR imaging in acute infectious cellulitis. Radiology 192:493–496PubMedGoogle Scholar
  5. 5.
    Beltran J (1995) MR imaging of soft-tissue infection. Magn Reson Imaging Clin N Am 3:743–751PubMedGoogle Scholar
  6. 6.
    Struk DW, Munk L, Lee MJ, Ho SG, Worsley DF (2001) Imaging of soft tissue infections. Radiol Clin North Am 39:277–303. doi: 10.1016/S0033-8389(05)70278-5 PubMedCrossRefGoogle Scholar
  7. 7.
    Christian S, Kraas J, Conway WF (2007) Musculoskeletal infections. Semin Roentgenol 42:92–101. doi: 10.1053/j.ro.2006.08.011 PubMedCrossRefGoogle Scholar
  8. 8.
    Bivjii AA, Paiement GD, Steinbach LS (2002) Musculoskeletal manifestations of human immunodeficiency virus infection. J Am Acad Orthop Surg 10:312–320Google Scholar
  9. 9.
    Beltran J, McGhee RB, Shaffer PB, Freedy RM, McCalla MS (1987) Infections of the musculoskeletal system: high-field strength MR imaging. Radiology 164:449–454PubMedGoogle Scholar
  10. 10.
    Horton LK, Jacobson JA, Powell A et al (2001) Sonography and radiography of soft-tissue foreign bodies. AJR Am J Roentgenol 175:1155–1159Google Scholar
  11. 11.
    Peterson JJ, Bancroft LW, Kransdorf MJ (2002) Wooden foreign bodies: imaging appearance. AJR Am J Roentgenol 178:557–562PubMedGoogle Scholar
  12. 12.
    Bureau NJ, Chhem RK, Cardinal E (1999) Musculoskeletal infections: US manifestations. Radiographics 19:1585–1592PubMedGoogle Scholar
  13. 13.
    Paydar KZ, Hansen SL, Charlebois ED, Harris HW, Young DM (2006) Inappropriate antibiotic use in soft tissue infections. Arch Surg 141:850–856. doi: 10.1001/archsurg.141.9.850 PubMedCrossRefGoogle Scholar
  14. 14.
    Frazee BW, Lynn J, Charlebois ED, Lambert L, Lowery D, Perdreau-Remington F (2005) High prevalence of methicillin-resistant Staphylococcus aureus in emergency department skin and soft tissue infections. Ann Emerg Med 45:311–320. doi: 10.1016/j.annemergmed.2004.10.011 PubMedCrossRefGoogle Scholar
  15. 15.
    Ma LD, McCarthy EF, Bluemke DA et al (1998) Differentiation of benign from malignant musculoskeletal lesions using MR imaging: pitfalls in MR evaluation of lesions with a cystic appearance. AJR Am J Roentgenol 170:1251–1258PubMedGoogle Scholar
  16. 16.
    Gozal D, Ziser A, Shupak A, Ariel A, Melamed Y (1986) Necrotizing fasciitis. Arch Surg 121:233–235PubMedGoogle Scholar
  17. 17.
    Anaya DA, Dellinger EP (2007) Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis 44:705–710. doi: 10.1086/511638 PubMedCrossRefGoogle Scholar
  18. 18.
    Voros D, Pissiotis C, Georgantas D, Katsaragakis S, Antoniou S, Papdimitriou J (1993) Role of early and extensive surgery in the treatment of severe necrotizing soft tissue infection. Br J Surg 80:1190–1191. doi: 10.1002/bjs.1800800943 PubMedCrossRefGoogle Scholar
  19. 19.
    Endorf FW, Supple KG, Gamelli RL (2005) The evolving characteristics and care of necrotizing soft-tissue infections. Burns 31:269–273. doi: 10.1016/j.burns.2004.11.008 PubMedCrossRefGoogle Scholar
  20. 20.
    Schmid MR, Kossman T, Duewell S (1998) Differentiation of necrotizing fasciitis and cellulitis using MR imaging. AJR Am J Roentgenol 170:615–620PubMedGoogle Scholar
  21. 21.
    Loh NN, Chen IY, Cheung LP, Li KC (1997) Deep fascial hyperintensity in soft-tissue abnormalities as revealed by T2-weighted MR imaging. AJR Am J Roentgenol 168:1301–1304PubMedGoogle Scholar
  22. 22.
    Brothers TE, Tagge DU, Stutley JE, Conway F, Del Schutte H, Byrne TK Jr (1998) Magnetic resonance imaging differentiates between necrotizing and non-necrotizing fasciitis of the lower extremity. J Am Coll Surg 187:416–421. doi: 10.1016/S1072-7515(98)00192-6 PubMedCrossRefGoogle Scholar
  23. 23.
    Fugitt JB, Puckett ML, Quigley MM, Kerr SM (2004) Necrotizing fasciitis. Radiographics 24:1472–1476. doi: 10.1148/rg.245035169 PubMedCrossRefGoogle Scholar
  24. 24.
    Bickels J, Ben-Sira L, Kessler A, Wientroub S (2002) Primary pyomyositis. J Bone Joint Surg 84A:2277–2286Google Scholar
  25. 25.
    Restrepo CS, Lemos DF, Gordillo H et al (2004) Imaging findings in musculoskeletal complications of AIDS. Radiographics 24:1029–1049. doi: 10.1148/rg.244035151 PubMedCrossRefGoogle Scholar
  26. 26.
    Soler R, Rodriguez E, Aguilera C, Fernandez R (2000) Magnetic resonance imaging of pyomyositis in 43 cases. Eur J Radiol 35:59–64. doi: 10.1016/S0720-048X(99)00108-4 PubMedCrossRefGoogle Scholar
  27. 27.
    Gordon BA, Martinez S, Collins AJ (1995) Pyomyositis: characteristics at CT and MR imaging. Radiology 197:279–286PubMedGoogle Scholar
  28. 28.
    Nunez-Hoyo M, Gardner CL, Motta AO, Ashmead JW (1993) Skeletal muscle infarction in diabetes: MR findings. J Comput Assist Tomogr 17:986–988PubMedCrossRefGoogle Scholar
  29. 29.
    Jelinek JS, Murphey MD, Aboulafia AJ, Dussault RG, Kaplan PA, Snearly WN (1999) Muscle infarction in patients with diabetes mellitus: MR imaging findings. Radiology 211:241–247PubMedGoogle Scholar
  30. 30.
    Yildirim Donmez F, Feldman F (2008) Muscle compromise in diabetes. Acta Radiol 49:673–679. doi: 10.1080/02841850802105269 PubMedCrossRefGoogle Scholar
  31. 31.
    Kattapuram TM, Suri R, Rosol MS, Rosenberg AE, Kattapuram SV (2005) Idiopathic and diabetic skeletal muscle necrosis: evaluation by magnetic resonance imaging. Skeletal Radiol 34:203–209. doi: 10.1007/s00256-004-0881-8 PubMedCrossRefGoogle Scholar
  32. 32.
    Chason DP, Fleckenstein JL, Burns DK, Rojas G (1996) Diabetic muscle infarction: radiologic evaluation. Skeletal Radiol 25:127–132. doi: 10.1007/s002560050048 PubMedCrossRefGoogle Scholar
  33. 33.
    Grigoriadis E, Fam AG, Starok M, Ang LC (2000) Skeletal muscle infarction in diabetes mellitus. J Rheumatol 27:1063–1068PubMedGoogle Scholar
  34. 34.
    Heppenstall RB, Scott R, Sapega A et al (1986) A comparative study of the tolerance of skeletal muscle to ischemia: tourniquet application compared with acute compartment syndrome. J Bone Joint Surg 68A:820–828Google Scholar
  35. 35.
    Tiwari A, Haq AI, Myint F, Hamilton G (2002) Acute compartment syndromes. Br J Surg 89:397–412. doi: 10.1046/j.0007-1323.2002.02063.x PubMedCrossRefGoogle Scholar
  36. 36.
    Konstantakos EK, Dalstrom DJ, Nelles ME, Laughlin RT, Prayson MJ (2007) Diagnosis and management of extremity compartment syndromes: an orthopaedic perspective. Am Surg 73:1199–1209PubMedGoogle Scholar
  37. 37.
    Rominger MB, Lukosch CJ, Bachmann GF (2004) MR imaging of compartment syndrome of the lower leg: a case control study. Eur Radiol 14:1432–1439. doi: 10.1007/s00330-004-2305-5 PubMedCrossRefGoogle Scholar
  38. 38.
    Schepsis AA, Martini D, Corbett M (1993) Surgical management of exertional compartment syndrome of the lower leg: long-term followup. Am J Sports Med 21:811–817. doi: 10.1177/036354659302100609 PubMedCrossRefGoogle Scholar
  39. 39.
    Eskelin MKK, Lotjonen J, Mantysaari MJ (1998) Chronic exertional compartment syndrome: MR imaging at 0.1 T compared with tissue pressure measurement. Radiology 206:333–337PubMedGoogle Scholar
  40. 40.
    Verleisdonk EJMM, van Gils A, van der Werken C (2001) The diagnostic value of MRI scans for the diagnosis of chronic exertional compartment syndrome of the lower leg. Skeletal Radiol 30:321–325. doi: 10.1007/s002560100361 PubMedCrossRefGoogle Scholar
  41. 41.
    Shintani S, Shiigai T (1993) Repeat MRI in acute rhabdomyolysis: correlation with clinicopathological findings. J Comput Assist Tomogr 17:786–791. doi: 10.1097/00004728-199309000-00023 PubMedCrossRefGoogle Scholar
  42. 42.
    Lu CH, Tsang YM, Yu CW, Wu MZ, Hsu CY, Shih TT (2007) Rhabdomyolysis: magnetic resonance imaging and computed tomography findings. J Comput Assist Tomogr 31:368–374. doi: 10.1097/01.rct.0000250115.10457.e9 PubMedCrossRefGoogle Scholar
  43. 43.
    Moratalla MB, Braun P, Fornas GM (2008) Importance of MRI in the diagnosis and treatment of rhabdomyolysis. Eur J Radiol 65:311–315. doi: 10.1016/j.ejrad.2007.03.033 PubMedCrossRefGoogle Scholar

Copyright information

© Am Soc Emergency Radiol 2008

Authors and Affiliations

  1. 1.The Ohio State UniversityColumbusUSA

Personalised recommendations