Skip to main content

Advertisement

SpringerLink
Log in

Unsuspected lower extremity deep venous thrombosis simulating musculoskeletal pathology

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

The purpose of this study was to highlight the critical role that MRI may play in diagnosing unsuspected lower extremity deep venous thrombosis and to stress the importance of scrutinizing MRI studies of the lower extremity showing apparently non-specific muscle edema for any evidence of intramuscular venous thrombosis.

Design and patients

The imaging studies of four patients in whom deep venous thrombosis was unsuspected on clinical grounds, and first diagnosed on the basis of MRI findings, were reviewed by two musculoskeletal radiologists in consensus. In all four patients the initial clinical suspicion was within the scope of musculoskeletal injuries (gastrocnemius strain, n=3; ruptured Baker cyst, n=1), explaining the choice of MRI over ultrasound as the first diagnostic modality.

Results

All patients showed marked reactive edema in the surrounding soft tissues or muscles. Three patients showed MR evidence of branching rim-enhancing structures within intramuscular plexuses characteristic of venous thrombosis (gastrocnemius, n=1; sural, n=2); one patient showed a distended popliteal vein. Ultrasound was able to duplicate the MRI findings in three patients: one patient showed above-the-knee extension on ultrasound; neither of the two patients with intramuscular thrombosis demonstrated on ultrasound showed extension to the deep venous trunks.

Conclusion

Intramuscular venous thrombosis can present as marked edema-like muscle changes on MRI, simulating primary musculoskeletal conditions. In the absence of clinical suspicion for deep venous thrombosis, only the identification of rim-enhancing branching intramuscular tubular structures will allow the correct diagnosis to be made.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Kattapuram TM, Suri R, Rosol MS, Rosenberg AE, Kattapuram SV. Idiopathic and diabetic skeletal muscle necrosis: evaluation by magnetic resonance imaging. Skeletal Radiol 2005;34:203–209

    Article  Google Scholar 

  2. Fleckenstein JL, Watumull D, Conner KE, et al. Denervated human skeletal muscle: MR imaging evaluation. Radiology 1993;187:213–218

    Article  CAS  Google Scholar 

  3. May DA, Disler DG, Jones EA, Balkissoon AA, Manaster BJ. Abnormal signal intensity in skeletal muscle at MR imaging: patterns, pearls, and pitfalls. Radiographics 2000;20:S295–S315

    Article  Google Scholar 

  4. Shintani S, Shiigai T. Repeat MRI in acute rhabdomyolysis: correlation with clinicopathological findings. J Comput Assist Tomogr 1993;17:786–791

    Article  CAS  Google Scholar 

  5. Evans GF, Haller RG, Wyrick PS, Parkey RW, Fleckenstein JL. Submaximal delayed-onset muscle soreness: correlations between MR imaging findings and clinical measures. Radiology 1998;208:815–820

    Article  CAS  Google Scholar 

  6. Ghaye B, Szapiro D, Willems V, Dondelinger RF. Pitfalls in CT venography of lower limbs and abdominal veins. AJR Am J Roentgenol 2002;178:1465–1471

    Article  CAS  Google Scholar 

  7. Loud Peter A, Katz Douglas S, Klippenstein Donald L, Shah Rakesh D, Grossman Zachary D. Combined CT venography and pulmonary angiography in suspected thromboembolic disease: diagnostic accuracy for deep venous evaluation. AJR Am J Roentgenol 2000;174:61–65

    Article  CAS  Google Scholar 

  8. Cham Matthew D, Yankelevitz David F, Shaham Dorith, Shah Ami A, Sherman Leonard, Lewis Andrew, Rademaker Jurgen, Pearson Gregory, Choi Junsung, Wolff William, Prabhu Pilar M, Galanski Michael, Clark Robert A, Sostman H Dirk, Henschke Claudia I. Deep venous thrombosis: detection by using indirect CT venography. Radiology 2000;216:744–751

    Article  CAS  Google Scholar 

  9. Macdonald PS, Kahn SR, Miller N, Obrand D. Short-term natural history of isolated gastrocnemius and soleal vein thrombosis. J Vasc Surg 2003;37:523–527

    Article  CAS  Google Scholar 

  10. Hollerweger A, Macheiner P, Rettenbacher T, Gritzmann N. Sonographic diagnosis of thrombosis of the calf muscle veins and the risk of pulmonary embolism. Ultraschall Med 2000;21:66–72

    Article  CAS  Google Scholar 

  11. Ohgi S, Tachibana M, Ikebuchi M, Kanaoka Y, Maeda T, Mori T. Pulmonary embolism in patients with isolated soleal vein thrombosis. Angiology 1998;49:759–764

    Article  CAS  Google Scholar 

  12. Krunes U, Teubner K, Knipp H, Holzapfel R. Thrombosis of the muscular calf veins—reference to a syndrome which receives little attention. Vasa 1998;27:172–175

    CAS  PubMed  Google Scholar 

  13. Labropoulos N, Webb KM, Kang SS, Mansour MA, Filliung DR, Size GP, Buckman J, Baker WH. Patterns and distribution of isolated calf deep vein thrombosis. J Vasc Surg 1999;30:787–791

    Article  CAS  Google Scholar 

  14. Atri M, Herba MJ, Reinhold C, Leclerc J, Ye S, Illescas FF, Bret PM. Accuracy of sonography in the evaluation of calf deep vein thrombosis in both postoperative surveillance and symptomatic patients. AJR Am J Roentgenol 1996;166:1361–1367

    Article  CAS  Google Scholar 

  15. Rumack CM, Wilson SR, Charboneau JW. Diagnostic ultrasound, 2nd ed. St. Louis, Mo: Mosby; 1998. pp. 944–949

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. DII—Diagnostic Imaging, Inc., Department of Radiology, Frankford Hospitals, Torresdale Campus, Red Lion and Knights Roads, Philadelphia, PA, 19114, USA

    Antoni J. Parellada, Sean B. Reiter, Peter L. Glickman & Linda A. Kloss

  2. Thomas Jefferson University, Philadelphia, PA, USA

    William B. Morrison

  3. Harvard Medical School, Brigham & Women’s Hospital, Boston, MA, USA

    John A. Carrino

  4. Frankford Hospitals, Jefferson Health System, Philadelphia, PA, USA

    Pinecca Patel

Authors
  1. Antoni J. Parellada
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. William B. Morrison
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sean B. Reiter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. John A. Carrino
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Peter L. Glickman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Linda A. Kloss
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Pinecca Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antoni J. Parellada.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Parellada, A.J., Morrison, W.B., Reiter, S.B. et al. Unsuspected lower extremity deep venous thrombosis simulating musculoskeletal pathology. Skeletal Radiol 35, 659–664 (2006). https://doi.org/10.1007/s00256-006-0128-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-006-0128-y

Keywords

Search

Navigation