Wong Kin Hoi, Chow Maria Bernadette Che Ying, Lui Tun Hing, Cheong Yue Kew, Tam Kwok Fai
Department of Radiology, North District Hospital, Sheung Shui, Hong Kong.
Department of Pathology, North District Hospital, Sheung Shui, Hong Kong.
Radiol Case Rep. 2017 Jul 25;12(4):815-820. doi: 10.1016/j.radcr.2017.06.011. eCollection 2017 Dec.
Denervation of muscle usually leads to muscle atrophy with fatty replacement but, uncommonly, also results in muscle hypertrophy or pseudohypertrophy with fatty replacement. We report the ultrasonographic and magnetic resonance imaging (MRI) findings of a patient with diffuse fatty infiltration of calf muscles as a result of denervation pseudohypertrophy. The elevated fasting glucose, neurogenic electromyographic changes, and muscle atrophy with adipose tissue infiltration are consistent with diabetic neuropathy as the cause of denervation pseudohypertrophy. Lumbosacral radiculopathy and plexopathy were excluded by MRI. The imaging features reported in the literature are reviewed. The important differential diagnosis of infiltrating lipoma and denervation hypertrophy, as well as other causes of monomelic hypertrophy or swelling, is discussed. This case report demonstrates the importance of MRI, with clinical, biochemical, electrophysiological, and histologic correlation in the diagnosis of denervation pseudohypertrophy. Correct diagnosis of denervation pseudohypertrophy has an important role in guiding further investigations and treatment of the disease and the underlying cause.
肌肉去神经支配通常会导致肌肉萎缩并伴有脂肪替代，但罕见的情况下也会导致肌肉肥大或假性肥大并伴有脂肪替代。我们报告了一名因去神经支配假性肥大导致小腿肌肉弥漫性脂肪浸润患者的超声和磁共振成像（MRI）表现。空腹血糖升高、神经源性肌电图改变以及伴有脂肪组织浸润的肌肉萎缩与糖尿病性神经病变相符，可作为去神经支配假性肥大的病因。MRI排除了腰骶神经根病和臂丛神经病。本文回顾了文献中报道的影像学特征。讨论了浸润性脂肪瘤与去神经支配性肥大以及单肢肥大或肿胀的其他原因的重要鉴别诊断。本病例报告证明了MRI在诊断去神经支配假性肥大时结合临床、生化、电生理和组织学检查的重要性。正确诊断去神经支配假性肥大对指导该疾病及其潜在病因的进一步检查和治疗具有重要作用。
