Diabetic muscle infarction: radiologic evaluation

 Objective. Diabetic muscle infarction (DMI) is frequently misdiagnosed clinically as abscess, neoplasm, or myositis, and is often biopsied. Clinical and radiologic findings are presented here to enable the radiologist to suggest the correct diagnosis. Design and patients. Four patients with severe diabetes mellitus presenting with acute thigh pain, tenderness, and swelling were evaluated by imaging techniques and biopsy. Results and conclusions. Edema in the affected muscles was seen in two patients with MRI studies. Femoral artery calcification and mild muscle swelling was present in one patient who underwent CT. Decreased echogenicity was seen in the involved muscle in a patient studied with ultrasound. Serum enzymes were normal or mildly elevated in three patients (not reported in one). Biopsy demonstrated necrosis and regenerative change in all cases. MRI, although nonspecific, is the best imaging technique to suggest the diagnosis of DMI in the appropriate clinical setting, thereby obviating biopsy.